Provider Demographics
NPI:1346340296
Name:YOUNG, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:YOUNG
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 1:3840 WATT AVE
Mailing Address - Street 2:BUILDING E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2640
Mailing Address - Country:US
Mailing Address - Phone:916-488-6200
Mailing Address - Fax:916-488-6300
Practice Address - Street 1:3840 WATT AVE
Practice Address - Street 2:BUILDING E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2640
Practice Address - Country:US
Practice Address - Phone:916-488-6200
Practice Address - Fax:916-488-6300
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346340296OtherINDIVIDUAL NPI
CA1881762953OtherGROUP NPI
CABB784ZOtherPTAN
ZZZ21878ZOtherGROUP PTAN
CABB784ZOtherPTAN
CA1881762953OtherGROUP NPI