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General NPI Number Information
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NPI Number | 1881023257
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Entity Type | Organization
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Legal Business Name | KSB GASTROENTEROLOGY
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 33 CREEK RD SUITE 380
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City | IRVINE
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State | CA
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Zip | 92604-4791
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Country | US
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Telephone | 949-517-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CREEK RD SUITE 380
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City | IRVINE
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State | CA
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Zip | 92604-4791
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Country | US
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Telephone | 949-517-8669
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KONG PENG YAP
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Credential | M.D.
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Telephone | 949-517-8669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A101486
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License Number State | CA
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