=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235535659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER S YOUNG DO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2014
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 558 N VENTU PARK RD SUITE A
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-498-8265
-----------------------------------------------------
Fax | 805-498-3689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 558 N VENTU PARK RD SUITE A
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-498-8265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER SUSAN YOUNG
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 626-548-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------