Healthcare Provider Details

I. General information

NPI: 1346843372
Provider Name (Legal Business Name): AUSTIN YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25657 PINE CREEK LN
WILMINGTON CA
90744-1823
US

IV. Provider business mailing address

PO BOX 437
HARBOR CITY CA
90710-0437
US

V. Phone/Fax

Practice location:
  • Phone: 310-999-9824
  • Fax:
Mailing address:
  • Phone: 310-999-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberP38080
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberP38080
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP38080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: