Provider Demographics
NPI:1568442648
Name:YOUNAN, K. GEORGE (MD PA)
Entity Type:Individual
Prefix:
First Name:K. GEORGE
Middle Name:
Last Name:YOUNAN
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:KIRVARKIS
Other - Middle Name:YALDA
Other - Last Name:YOUNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1145 BORDENTOWN AVE
Mailing Address - Street 2:STE #10
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859
Mailing Address - Country:US
Mailing Address - Phone:732-727-5376
Mailing Address - Fax:732-727-1391
Practice Address - Street 1:1145 BORDENTOWN AVE
Practice Address - Street 2:STE #10
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859
Practice Address - Country:US
Practice Address - Phone:732-727-0400
Practice Address - Fax:732-727-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29755207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004448Medicaid
NJ460738TUMMedicare ID - Type Unspecified
NJ0004448Medicaid