=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063917805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN EDWARD YOUNG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2018
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 WYOMING ST
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45409-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-223-4461
-----------------------------------------------------
Fax | 937-449-7603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 WYOMING ST
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45409-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-277-4274
-----------------------------------------------------
Fax | 937-641-2655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 35.141997
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------