Healthcare Provider Details

I. General information

NPI: 1417019258
Provider Name (Legal Business Name): YOUNG YOUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 DICKINSON DRIVE
RUSK TX
75785
US

IV. Provider business mailing address

HOSPITAL DRIVE #999
RUSK TX
75785
US

V. Phone/Fax

Practice location:
  • Phone: 903-683-7201
  • Fax:
Mailing address:
  • Phone: 903-683-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE8239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: