Healthcare Provider Details

I. General information

NPI: 1184615460
Provider Name (Legal Business Name): STEVEN KENNETH YOUNG CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 280TH PL NE
CARNATION WA
98014-8218
US

IV. Provider business mailing address

2030 280TH PL NE
CARNATION WA
98014-8218
US

V. Phone/Fax

Practice location:
  • Phone: 425-333-4434
  • Fax: 425-333-4462
Mailing address:
  • Phone: 425-333-4434
  • Fax: 425-333-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA 00157
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberST00001591
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: