Provider Demographics
NPI:1275774085
Name:YOUNG, KAYON (PA)
Entity Type:Individual
Prefix:MISS
First Name:KAYON
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6953 75TH ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2532
Mailing Address - Country:US
Mailing Address - Phone:315-783-1305
Mailing Address - Fax:
Practice Address - Street 1:6953 75TH ST
Practice Address - Street 2:2ND FLR
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2532
Practice Address - Country:US
Practice Address - Phone:315-783-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013173-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant