Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G46932 | CA |
N | 111NI0900X | Internist | G46932 | CA |
Y | 207RN0300X | Nephrologist | G46932 | CA |
NPI | 1033205604 |
---|---|
Provider Name | Jeffry Howard Young |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95128-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G469320 | (05) | CA |
A50545 | (02) | CA |