Provider Demographics
NPI:1114000973
Name:YOUNG, KIMBERLY ALLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALLISON
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 978
Mailing Address - Street 2:
Mailing Address - City:STINSON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94970-0978
Mailing Address - Country:US
Mailing Address - Phone:415-868-9656
Mailing Address - Fax:415-868-2858
Practice Address - Street 1:3419 STATE ROUTE ONE
Practice Address - Street 2:
Practice Address - City:STINSON BEACH
Practice Address - State:CA
Practice Address - Zip Code:94970
Practice Address - Country:US
Practice Address - Phone:415-868-9656
Practice Address - Fax:415-868-2858
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH72024Medicare UPIN