Healthcare Provider Details

I. General information

NPI: 1346203874
Provider Name (Legal Business Name): YOUNG HUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 INDIAN WELLS AVE
KISSIMMEE FL
34759-3679
US

IV. Provider business mailing address

461 INDIAN WELLS AVE
KISSIMMEE FL
34759-3679
US

V. Phone/Fax

Practice location:
  • Phone: 732-735-8401
  • Fax:
Mailing address:
  • Phone: 732-735-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA03066300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA03066300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: