Provider Demographics
NPI:1598795999
Name:YOUNG, CAROLYN M (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TEARDROP
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0668
Mailing Address - Country:US
Mailing Address - Phone:949-387-6230
Mailing Address - Fax:
Practice Address - Street 1:27799 MEDICAL CENTER RD STE 120
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6400
Practice Address - Country:US
Practice Address - Phone:949-573-9560
Practice Address - Fax:949-364-4276
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA374782085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103710Medicaid
CA00A374780Medicaid
CA00A374780Medicaid
WA37478HMedicare PIN
WA37478HMedicare PIN
W18392Medicare PIN