Provider Demographics
NPI:1174655013
Name:JOHN A. YOUNG, M.D., INC.
Entity Type:Organization
Organization Name:JOHN A. YOUNG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ABBOT
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-806-1400
Mailing Address - Street 1:2095 W VISTA WAY #106
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-806-1400
Mailing Address - Fax:760-806-1420
Practice Address - Street 1:2095 W VISTA WAY STE 106
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6028
Practice Address - Country:US
Practice Address - Phone:760-806-1400
Practice Address - Fax:760-806-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG38706Medicare ID - Type UnspecifiedSTATE LICENSE NUMBER