Healthcare Provider Details

I. General information

NPI: 1497634810
Provider Name (Legal Business Name): JAKUB YOUNGSTROM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JESSUP HALL
IOWA CITY IA
52242-1316
US

IV. Provider business mailing address

1146 PARK CT
HASTINGS MN
55033-2548
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberNA
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: