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General NPI Number Information
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NPI Number | 1629639505
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Entity Type | Individual
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Provider Name | VIVIAN YIP DMD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2019
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Last Update Date | 06/22/2019
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Provider Practice Location Address
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Address Line | 8975 W CHARLESTON BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89117-5473
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Country | US
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Telephone | 702-290-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 CAST PEBBLE DR
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City | LAS VEGAS
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State | NV
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Zip | 89135-1135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7205
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License Number State | NV
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