MEDICARE: BENITA KHO YOUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	A35719	CA

General Provider Information

NPI Number	:	1013006949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITA KHO YOUNG MD

Provider Business Mailing Address
First Line	:	1505 S SHEPARD DR
Second Line	:	STE 103
City	:	SANTA MARIA
State	:	CA
Zip	:	93454
Country	:	US
Telephone Number	:	805-922-0439
Fax Number	:	805-922-8219

Provider Business Practice Location Address
First Line	:	1505 SHEPARD DR
Second Line	:	STE 103
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-7020
Country	:	US
Telephone Number	:	805-922-0439
Fax Number	:	805-922-8219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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