Healthcare Provider Details

I. General information

NPI: 1063098150
Provider Name (Legal Business Name): JONATHAN HUBERT YOUNG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 S 44TH PL
PHOENIX AZ
85040-4010
US

IV. Provider business mailing address

750 W JOHN CARPENTER FWY STE 800
IRVING TX
75039-2520
US

V. Phone/Fax

Practice location:
  • Phone: 866-771-8946
  • Fax:
Mailing address:
  • Phone: 866-771-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number80085
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: