Provider Demographics
NPI:1043525231
Name:YOUNG CLINIC, PC
Entity Type:Organization
Organization Name:YOUNG CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNGDONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-231-6152
Mailing Address - Street 1:2216 ROYAL LN
Mailing Address - Street 2:STE 113
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3309
Mailing Address - Country:US
Mailing Address - Phone:469-231-6152
Mailing Address - Fax:972-243-2206
Practice Address - Street 1:2216 ROYAL LN
Practice Address - Street 2:STE 113
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-3309
Practice Address - Country:US
Practice Address - Phone:469-231-6152
Practice Address - Fax:972-243-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10609111N00000X
TX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1811161482OtherINDIVIDUAL NPI
=========OtherTIN