Healthcare Provider Details

I. General information

NPI: 1295760460
Provider Name (Legal Business Name): LUCIANA T YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL - RC.2.820
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 5371 4800 SAND POINT WAY NE - RC.2.820
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-7495
  • Fax: 206-987-3839
Mailing address:
  • Phone: 206-987-7495
  • Fax: 206-987-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD60676179
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: