Healthcare Provider Details

I. General information

NPI: 1518118678
Provider Name (Legal Business Name): LESTER SHINCHEN YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902-3799
US

IV. Provider business mailing address

2811 TIETON DR
YAKIMA WA
98902-3799
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-3946
  • Fax:
Mailing address:
  • Phone: 509-575-3946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61103790
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number68579
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number68579
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD61103790
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number68579
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number68579
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD61103790
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: