Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A150555 | CA |
N | 111NI0900X | Internist | A150555 | CA |
Y | 207RA0201X | Internist - Allergy & Immunology | A150555 | CA |
N | 208000000X | Pediatrician | A150555 | CA |
N | 2080P0201X | Pediatric Allergist | A150555 | CA |
NPI | 1295198919 |
---|---|
Provider Name | Dr. Fernanda D Young |
First Address | San Francisco, CA 94143 |
Second Address | San Francisco, CA 94143-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 05/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FD3232267556 | (05) | CA |