MEDICARE: DR. ANNA N YOUNG DDS, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	061749	NY

General Provider Information

NPI Number	:	1194163212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA N YOUNG DDS, MD

Provider Business Mailing Address
First Line	:	6118 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1009
Country	:	US
Telephone Number	:	347-590-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	6118 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1009
Country	:	US
Telephone Number	:	347-590-9910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	09/30/2021

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