Provider Demographics
NPI:1487679825
Name:YOUNG, ROYDEN S (MD)
Entity Type:Individual
Prefix:
First Name:ROYDEN
Middle Name:S
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:PO BOX 25370
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0370
Mailing Address - Country:US
Mailing Address - Phone:808-536-0314
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:1380 LUSITANA ST STE 904
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2448
Practice Address - Country:US
Practice Address - Phone:808-599-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11288207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI499196Medicaid
HIH53321Medicare PIN