Provider Demographics
NPI:1043521008
Name:YOUNG, SONNY (DO)
Entity Type:Individual
Prefix:DR
First Name:SONNY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SHOREWAY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2788
Mailing Address - Country:US
Mailing Address - Phone:650-556-9420
Mailing Address - Fax:
Practice Address - Street 1:125 SHOREWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2788
Practice Address - Country:US
Practice Address - Phone:650-556-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine