Healthcare Provider Details

I. General information

NPI: 1063917805
Provider Name (Legal Business Name): STEVEN EDWARD YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WYOMING ST
DAYTON OH
45409-2731
US

IV. Provider business mailing address

122 WYOMING ST
DAYTON OH
45409-2731
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4461
  • Fax: 937-449-7603
Mailing address:
  • Phone: 937-277-4274
  • Fax: 937-641-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.141997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: