Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 103217 | CA |
NPI | 1699242933 |
---|---|
Provider Name | Dr. Albert Young |
First Address | San Diego, CA 92134-0001 |
Second Address | San Diego, CA 92134-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 25/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD0000 | (05) | CA |