Provider Demographics
NPI:1053379768
Name:YAP, LUI KONG (PA-C)
Entity type:Individual
Prefix:MR
First Name:LUI
Middle Name:KONG
Last Name:YAP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:BERNARD
Other - Middle Name:LUI-KONG
Other - Last Name:YAP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 10069
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0069
Mailing Address - Country:US
Mailing Address - Phone:909-335-4188
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND SPRINGS AVE
Practice Address - Street 2:STE.200
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-845-0313
Practice Address - Fax:951-769-1300
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13990363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ70323Medicare UPIN