Provider Demographics
NPI:1407251192
Name:YAP, VIDA ROSE
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:ROSE
Last Name:YAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 IKE DR
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9718
Mailing Address - Country:US
Mailing Address - Phone:808-579-8414
Mailing Address - Fax:808-579-8426
Practice Address - Street 1:1931 BALDWIN AVENUE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768
Practice Address - Country:US
Practice Address - Phone:808-579-8414
Practice Address - Fax:808-579-9744
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor