Provider Demographics
NPI:1760594543
Name:YIP, DAVID SUNG-YEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SUNG-YEN
Last Name:YIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3654 WEST ANTHEM WAY
Mailing Address - Street 2:SUITE B-114
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-0442
Mailing Address - Fax:623-551-0830
Practice Address - Street 1:3654 W ANTHEM WAY
Practice Address - Street 2:SUITE B-114
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0455
Practice Address - Country:US
Practice Address - Phone:623-551-0442
Practice Address - Fax:623-551-0830
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29335208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ577794Medicaid