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General NPI Number Information
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NPI Number | 1649921206
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Entity Type | Individual
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Provider Name | TYLER JACOB YOUNG DDS
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Gender | Male
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 1288 SCOTT BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95050-4517
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Country | US
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Telephone | 408-984-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 77 N ALMADEN AVE APT 511
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City | SAN JOSE
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State | CA
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Zip | 95110-2781
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Country | US
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Telephone | 510-910-5459
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS107173
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License Number State | CA
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