MEDICARE: HARRIET YOUNG DMD

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	122300000X	Dentist	DT-3318	HI

General Provider Information

NPI Number	:	1558296657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIET YOUNG DMD

Provider Business Mailing Address
First Line	:	505 COUNTRY CLUB DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 WAIALAE AVE STE 210
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5312
Country	:	US
Telephone Number	:	808-732-1424
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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