Provider Demographics
NPI:1558864678
Name:JAPA, KIRSY BETHANIA (MD)
Entity Type:Individual
Prefix:
First Name:KIRSY
Middle Name:BETHANIA
Last Name:JAPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRSY
Other - Middle Name:BETHANIA
Other - Last Name:JAPA-TORIBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3377
Mailing Address - Country:US
Mailing Address - Phone:215-746-7248
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD4697622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program