Healthcare Provider Details

I. General information

NPI: 1982910667
Provider Name (Legal Business Name): JEFFREY C. YOUNG, D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W LAS TUNAS DR STE 205
SAN GABRIEL CA
91776-1236
US

IV. Provider business mailing address

416 W LAS TUNAS DR STE 205
SAN GABRIEL CA
91776-1236
US

V. Phone/Fax

Practice location:
  • Phone: 626-571-7958
  • Fax: 626-571-7293
Mailing address:
  • Phone: 626-571-7958
  • Fax: 626-571-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6648
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY C YOUNG
Title or Position: CEO
Credential: D.O.
Phone: 626-571-7958