Healthcare Provider Details

I. General information

NPI: 1275213712
Provider Name (Legal Business Name): KRAIG L. YOUNG, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 YOUNG ST STE 104
HONOLULU HI
96814-1991
US

IV. Provider business mailing address

1109 YOUNG ST STE 104
HONOLULU HI
96814-1991
US

V. Phone/Fax

Practice location:
  • Phone: 808-728-5040
  • Fax:
Mailing address:
  • Phone: 808-728-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRAIG LEUNG HUNE YOUNG
Title or Position: PHYSICIAN
Credential: MD
Phone: 808-728-5040