Healthcare Provider Details

I. General information

NPI: 1851560205
Provider Name (Legal Business Name): YOUNG-SAM WON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 WORTH ST SUITE 170
DALLAS TX
75246-2006
US

IV. Provider business mailing address

3535 WORTH ST SUITE 170
DALLAS TX
75246-2006
US

V. Phone/Fax

Practice location:
  • Phone: 214-370-1618
  • Fax: 214-370-1622
Mailing address:
  • Phone: 214-370-1618
  • Fax: 214-370-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number38213
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5302028447
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: