Healthcare Provider Details

I. General information

NPI: 1568440881
Provider Name (Legal Business Name): YOUNG M D AND BOOHAR M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS SEQUOIA HOSPITAL RADIATION ONCOLOGY DEPT
REDWOOD CITY CA
94062
US

IV. Provider business mailing address

450 GLASS LN STE C
MODESTO CA
95356-9287
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number36770
License Number StateCA

VIII. Authorized Official

Name: C DALE YOUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 209-342-2300