Provider Demographics
NPI:1164106852
Name:YOUNG, DESMOND LONNELL
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:LONNELL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16318 128TH PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-5506
Mailing Address - Country:US
Mailing Address - Phone:206-446-3125
Mailing Address - Fax:
Practice Address - Street 1:1412 140TH PL NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3915
Practice Address - Country:US
Practice Address - Phone:425-747-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker