1629111208 NPI number — DR. EUGENE Y YOUNG D.O.

Table of content: DR. EUGENE Y YOUNG D.O. (NPI 1629111208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629111208 NPI number — DR. EUGENE Y YOUNG D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
EUGENE
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629111208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5282
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACIENDA HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91745-0282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-625-6646
Provider Business Mailing Address Fax Number:
562-697-8027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 E WHITTIER BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-3885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-625-6646
Provider Business Practice Location Address Fax Number:
626-202-1273
Provider Enumeration Date:
02/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  20A6879 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)