Healthcare Provider Details

I. General information

NPI: 1497454102
Provider Name (Legal Business Name): BRIANNA KRISTEN YOUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

4476 TWEEDY BLVD
SOUTH GATE CA
90280-6359
US

V. Phone/Fax

Practice location:
  • Phone: 323-825-8300
  • Fax: 323-268-9119
Mailing address:
  • Phone: 323-825-8300
  • Fax: 323-268-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95021104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: