Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 012562 | MO |
NPI | 1679583637 |
---|---|
Provider Name | Dr. Peggy Jean Young |
First Address | Kansas City, MO 64130-2807 |
Second Address | Kansas City, MO 64130-2807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 07/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400586103 | (05) | MO |