=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407977713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD F YOUNG MD INC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1560 N 115TH ST STE G5
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-8414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-368-1626
-----------------------------------------------------
Fax | 206-368-1631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1560 N 115TH #G5
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-368-1626
-----------------------------------------------------
Fax | 206-368-1631
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RONALD F YOUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-368-1626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------