Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 032787 | CA |
NPI | 1023214368 |
---|---|
Provider Name | Dr. Glen C Young |
First Address | San Francisco, CA 94121-2207 |
Second Address | San Francisco, CA 94121-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2007 |