Provider Demographics
NPI:1649296922
Name:YIP, PENELOPE (DDS)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:YIP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice