Provider Demographics
NPI:1235904715
Name:YUNG, SAMUEL (CPO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:YUNG
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 HARBOR BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1360
Mailing Address - Country:US
Mailing Address - Phone:714-210-1298
Mailing Address - Fax:
Practice Address - Street 1:16520 HARBOR BLVD STE G
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1360
Practice Address - Country:US
Practice Address - Phone:714-210-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO04401222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist