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General NPI Number Information
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NPI Number | 1629110390
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Entity Type | Individual
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Provider Name | BRADLEY JAMES YOUNG PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4760 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6063
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Country | US
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Telephone | 323-783-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6063
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Country | US
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Telephone | 800-954-8000
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 14403
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License Number State | CA
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