Provider Demographics
NPI:1346673217
Name:YIP, KA WA (MS)
Entity Type:Individual
Prefix:
First Name:KA
Middle Name:WA
Last Name:YIP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 VAN SICKLEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3802
Mailing Address - Country:US
Mailing Address - Phone:347-633-7797
Mailing Address - Fax:
Practice Address - Street 1:344 VAN SICKLEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3802
Practice Address - Country:US
Practice Address - Phone:347-633-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY451659OtherNEW YORK STATE EDUCATION DEPARTMENT