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General NPI Number Information
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NPI Number | 1811911050
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Entity Type | Individual
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Provider Name | JASON J DE YOUNG M.D., PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 4647 ZION AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 858-528-7266
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Fax | 858-528-6161
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Provider Business Mailing Address
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Address Line | 4647 ZION AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 858-528-7266
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Fax | 858-528-6161
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00039239
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD155033
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A112228
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License Number State | CA
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