Provider Demographics
NPI:1346203874
Name:HUR, YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:HUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 INDIAN WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3679
Mailing Address - Country:US
Mailing Address - Phone:732-735-8401
Mailing Address - Fax:
Practice Address - Street 1:461 INDIAN WELLS AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3679
Practice Address - Country:US
Practice Address - Phone:732-735-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03066300207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6921205Medicaid
NJ6921205Medicaid
NJA84106Medicare UPIN