Provider Demographics
NPI:1073543641
Name:OWYOUNG, NELSON JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:JAMES
Last Name:OWYOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 S GARFIELD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4768
Mailing Address - Country:US
Mailing Address - Phone:626-570-4708
Mailing Address - Fax:626-570-4348
Practice Address - Street 1:1048 S GARFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4768
Practice Address - Country:US
Practice Address - Phone:626-570-4708
Practice Address - Fax:626-570-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA404752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A404751Medicaid
E79771Medicare UPIN
CA00A404751Medicaid