Provider Demographics
NPI:1407402605
Name:CHAN, EVELYN YIP (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:YIP
Last Name:CHAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3314
Mailing Address - Country:US
Mailing Address - Phone:323-259-2657
Mailing Address - Fax:323-341-4970
Practice Address - Street 1:1600 CAMPUS RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-3314
Practice Address - Country:US
Practice Address - Phone:323-259-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760547163W00000X
CA95013092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse