Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G38706 | CA |
NPI | 1114916988 |
---|---|
Provider Name | Dr. John A Young |
First Address | Vista, CA 92083-6028 |
Second Address | Vista, CA 92083-6027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A47571 | (02) | CA |