Provider Demographics
NPI:1710187638
Name:YIP, SAMUEL (MD,PHD,FRCPC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:YIP
Suffix:
Gender:M
Credentials:MD,PHD,FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 LEBON DR
Mailing Address - Street 2:#3211
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4593
Mailing Address - Country:US
Mailing Address - Phone:619-502-1451
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-6266
Practice Address - Fax:619-543-5793
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1007062084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology