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General NPI Number Information
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NPI Number | 1467280545
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Entity Type | Individual
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Provider Name | SHAE YOUNG
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Gender | Female
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 7435 W MANCHESTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90045-2376
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Country | US
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Telephone | 310-910-7348
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W B ST FL 4
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City | SAN DIEGO
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State | CA
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Zip | 92101-3537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 20901
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 114209
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License Number State | CA
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