Provider Demographics
NPI:1073701777
Name:YOUNG, S.ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:S.ALEX
Middle Name:
Last Name:YOUNG
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 1:18804 MADRONE RD
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-0320
Mailing Address - Country:US
Mailing Address - Phone:559-673-6450
Mailing Address - Fax:559-673-0389
Practice Address - Street 1:2339 W CLEVELAND AVE # 103
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-8753
Practice Address - Country:US
Practice Address - Phone:559-673-8055
Practice Address - Fax:559-673-0389
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346640Medicare PIN