Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A25750 | CA |
NPI | 1528127800 |
---|---|
Provider Name | Dr. Anthony Fulman Yipp |
First Address | San Gabriel, CA 91776-3607 |
Second Address | San Gabriel, CA 91776-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A257501 | (05) | CA |