Healthcare Provider Details

I. General information

NPI: 1679669782
Provider Name (Legal Business Name): PHILIP A YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 116TH AVE NE STE 102
BELLEVUE WA
98004-3058
US

IV. Provider business mailing address

1810 116TH AVE NE STE 102
BELLEVUE WA
98004-3058
US

V. Phone/Fax

Practice location:
  • Phone: 425-990-3223
  • Fax:
Mailing address:
  • Phone: 425-990-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA74959
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA74959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: