Healthcare Provider Details

I. General information

NPI: 1669638367
Provider Name (Legal Business Name): PATSY P YIP D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15640 REDMOND WAY
REDMOND WA
98052-3831
US

IV. Provider business mailing address

15640 REDMOND WAY
REDMOND WA
98052-3831
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-5533
  • Fax:
Mailing address:
  • Phone: 425-881-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60283465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: