Provider Demographics
NPI:1063509040
Name:KWONG, IVY YIP (DPT)
Entity Type:Individual
Prefix:DR
First Name:IVY
Middle Name:YIP
Last Name:KWONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OAK RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3326
Mailing Address - Country:US
Mailing Address - Phone:510-268-1118
Mailing Address - Fax:510-268-9905
Practice Address - Street 1:1901 VAN NESS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3007
Practice Address - Country:US
Practice Address - Phone:510-268-1118
Practice Address - Fax:510-268-9905
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist