Healthcare Provider Details

I. General information

NPI: 1831231810
Provider Name (Legal Business Name): KELLY YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 480
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST BOX 480
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3501
  • Fax: 310-782-1763
Mailing address:
  • Phone: 310-222-3501
  • Fax: 310-782-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberG75667
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberG75667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: