Provider Demographics
NPI:1114126091
Name:YIP, JEANINE ODETTE (DPT)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:ODETTE
Last Name:YIP
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 1:1540 EAST ALCAZAR STREET, CHP 155
Mailing Address - Street 2:USC DIVISION OF BIOKINESIOLOGY AND PHYSICAL THERAPY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:213-399-2334
Mailing Address - Fax:323-442-1515
Practice Address - Street 1:1640 MARENGO STREET
Practice Address - Street 2:USC FACULTY PRACTICE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:213-399-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23658225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist