MEDICARE: KIRK YOUNGMAN D.M.D.

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	1223G0001X	General Practice Dentistry	31888	CA

General Provider Information

NPI Number	:	1740517580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK YOUNGMAN D.M.D.

Provider Business Mailing Address
First Line	:	8013 LAGUNA BLVD
Second Line	:	STE #2
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7920
Country	:	US
Telephone Number	:	916-350-0981
Fax Number	:	916-691-6022

Provider Business Practice Location Address
First Line	:	8013 LAGUNA BLVD
Second Line	:	STE #2
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7920
Country	:	US
Telephone Number	:	916-350-0981
Fax Number	:	916-691-6022

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

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	09/02/2010

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