Provider Demographics
NPI:1417050048
Name:ANGEL PEDIATRICS PLLC
Entity Type:Organization
Organization Name:ANGEL PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-685-9500
Mailing Address - Street 1:3654 WEST ANTHEM WAY
Mailing Address - Street 2:SUITE B114
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0455
Mailing Address - Country:US
Mailing Address - Phone:623-551-0442
Mailing Address - Fax:623-551-0830
Practice Address - Street 1:3654 WEST ANTHEM WAY
Practice Address - Street 2:SUITE B114
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0455
Practice Address - Country:US
Practice Address - Phone:623-551-0442
Practice Address - Fax:623-551-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106667OtherAHCCCS