Provider Demographics
NPI:1114015369
Name:YOUNG, GRACE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:JEAN
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 8797
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8797
Mailing Address - Country:US
Mailing Address - Phone:714-817-7878
Mailing Address - Fax:714-277-4063
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:STE 104
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-817-7878
Practice Address - Fax:714-277-4063
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine