Provider Demographics
NPI:1578615373
Name:LIP, KWUN-SHAN (MD)
Entity Type:Individual
Prefix:
First Name:KWUN-SHAN
Middle Name:
Last Name:LIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:1600 AMPHITHEATRE PKWY BLDG 40
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1351
Practice Address - Country:US
Practice Address - Phone:888-201-1937
Practice Address - Fax:650-227-1107
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A737500Medicaid
CA00A737500Medicaid
H32472Medicare UPIN