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General NPI Number Information
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NPI Number | 1487233805
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Entity Type | Individual
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Provider Name | CASEY LEE YOUNG
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Gender | Male
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Dates
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Enumeration Date | 04/04/2021
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 3801 UNIVERSITY DR
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City | FAIRFAX
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State | VA
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Zip | 22030-2503
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Country | US
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Telephone | 703-383-8130
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Fax |
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Provider Business Mailing Address
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Address Line | 8910 JACKSON AVE
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City | MANASSAS
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State | VA
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Zip | 20110-4958
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Country | US
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Telephone | 703-853-5416
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 0110009393
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License Number State | VA
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