Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 29537 | CA |
NPI | 1124062260 |
---|---|
Provider Name | Dr. Alan D. Young |
First Address | Garden Grove, CA 92840-4875 |
Second Address | Garden Grove, CA 92840-4875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/07/2007 |