Provider Demographics
NPI:1891520284
Name:SAE-YUP, PIPAT
Entity type:Individual
Prefix:
First Name:PIPAT
Middle Name:
Last Name:SAE-YUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 TREMONT ST APT 801
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1632
Mailing Address - Country:US
Mailing Address - Phone:857-424-9919
Mailing Address - Fax:
Practice Address - Street 1:1575 TREMONT ST APT 801
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-1632
Practice Address - Country:US
Practice Address - Phone:857-424-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3015807207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology