Provider Demographics
NPI:1568675783
Name:PENELOPE S.YIP D.D.S., INC.
Entity Type:Organization
Organization Name:PENELOPE S.YIP D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:S
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-841-7424
Mailing Address - Street 1:2821 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1118
Mailing Address - Country:US
Mailing Address - Phone:510-841-7424
Mailing Address - Fax:510-841-5066
Practice Address - Street 1:2821 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1118
Practice Address - Country:US
Practice Address - Phone:510-841-7424
Practice Address - Fax:510-841-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty