Provider Demographics
NPI:1528127800
Name:YIPP, ANTHONY FULMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FULMAN
Last Name:YIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:FULMAN
Other - Last Name:YIPPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:808 E VALLEY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3607
Mailing Address - Country:US
Mailing Address - Phone:626-300-0885
Mailing Address - Fax:626-300-0056
Practice Address - Street 1:808 E VALLEY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3607
Practice Address - Country:US
Practice Address - Phone:626-300-0885
Practice Address - Fax:626-300-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25750204C00000X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A257501Medicaid
CA00A257501Medicaid