Healthcare Provider Details

I. General information

NPI: 1164334389
Provider Name (Legal Business Name): DARRYL YOUNG ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEADOWBROOK
IRVINE CA
92604-4726
US

IV. Provider business mailing address

22910 ESTORIL DR UNIT 3
DIAMOND BAR CA
91765-5407
US

V. Phone/Fax

Practice location:
  • Phone: 909-272-6844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1366375933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: