Provider Demographics
NPI:1518719442
Name:YIP, BO KYONG
Entity Type:Individual
Prefix:
First Name:BO KYONG
Middle Name:
Last Name:YIP
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:PO BOX 240202
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96824-0202
Mailing Address - Country:US
Mailing Address - Phone:808-800-2718
Mailing Address - Fax:
Practice Address - Street 1:2330 KALAKAUA AVE STE 214
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-5045
Practice Address - Country:US
Practice Address - Phone:808-800-2718
Practice Address - Fax:808-800-2718
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI359156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician