Healthcare Provider Details

I. General information

NPI: 1346047826
Provider Name (Legal Business Name): KEVIN YIP PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MERRICK AVE
WESTBURY NY
11590-6608
US

IV. Provider business mailing address

761 MERRICK AVE
WESTBURY NY
11590-6608
US

V. Phone/Fax

Practice location:
  • Phone: 888-972-8516
  • Fax:
Mailing address:
  • Phone: 888-972-8516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number032354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: