1912399783 NPI number — DR. JOANNA YOUNG MD

Table of content: DR. JOANNA YOUNG MD (NPI 1912399783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912399783 NPI number — DR. JOANNA YOUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
JOANNA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICE
Provider Other First Name:
JOANNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912399783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14445 OLIVE VIEW DR. 1A133
Provider Second Line Business Mailing Address:
OLIVE VIEW MEDICAL CENTER DEPARTMENT OF PATHOLOGY
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-364-3532
Provider Business Mailing Address Fax Number:
818-364-4065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14445 OLIVE VIEW DR. 1A133
Provider Second Line Business Practice Location Address:
OLIVE VIEW MEDICAL CENTER DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-364-3532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2015

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: 207ZF0201X , with the licence number:  A77360 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: A77360 , 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)