Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C36975 | CA |
N | 208000000X | Pediatrician | C36975 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | C36975 | CA |
NPI | 1043260458 |
---|---|
Provider Name | Dr. Matt Young |
First Address | West Hills, CA 91307-1938 |
Second Address | West Hills, CA 91307-4115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 11/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B50689 | (02) | CA |