Provider Demographics
NPI:1972566057
Name:YIP, WAI CHUN (MD)
Entity Type:Individual
Prefix:
First Name:WAI
Middle Name:CHUN
Last Name:YIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 WINDWARD PASSAGE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7741
Mailing Address - Country:US
Mailing Address - Phone:561-733-3970
Mailing Address - Fax:561-733-3690
Practice Address - Street 1:4895 WINDWARD PASSAGE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7741
Practice Address - Country:US
Practice Address - Phone:561-733-3970
Practice Address - Fax:561-733-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250872900Medicaid
FL32527Medicare ID - Type Unspecified
FL250872900Medicaid