Healthcare Provider Details

I. General information

NPI: 1851079727
Provider Name (Legal Business Name): JOHN WESLEY YOUNG JR. DOCTOR OF SCIENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 COCHISE TRL
WINCHESTER VA
22602-1511
US

IV. Provider business mailing address

5510 CHEROKEE AVE STE 300 #1233
ALEXANDRIA VA
22312
US

V. Phone/Fax

Practice location:
  • Phone: 202-276-4206
  • Fax:
Mailing address:
  • Phone: 703-822-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: