Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS040135 | PA |
Y | 1223D0004X | Dentist Anesthesiologist | 64084 | CA |
NPI | 1417359191 |
---|---|
Provider Name | Andrew Sing Young |
First Address | Walnut, CA 91789-1351 |
Second Address | Playa Del Rey, CA 90293-7962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 17/03/2018 |