Provider Demographics
NPI:1275554941
Name:YOUNG, VICTORIA K (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
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 1:11939 RANCHO BERNARDO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2074
Mailing Address - Country:US
Mailing Address - Phone:858-618-1156
Mailing Address - Fax:858-618-3314
Practice Address - Street 1:11939 RANCHO BERNARDO RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2074
Practice Address - Country:US
Practice Address - Phone:858-618-1156
Practice Address - Fax:858-618-3314
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016748820001Medicaid
PA1016748820001Medicaid
PA108742MK1Medicare PIN