Provider Demographics
NPI:1639250152
Name:YUNG, ANTHONY C (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:C
Last Name:YUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9633 LEVIN RD NW STE 202
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7998
Mailing Address - Country:US
Mailing Address - Phone:360-698-2505
Mailing Address - Fax:360-698-2514
Practice Address - Street 1:9633 LEVIN RD NW STE 202
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7998
Practice Address - Country:US
Practice Address - Phone:360-698-2505
Practice Address - Fax:360-698-2514
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000766213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9112YUOtherREGENCE RIDER
WA7125180Medicaid
WA0188446OtherL&I
WA1801065040OtherGROUP NPI EFFECTIVE 01012008
WA9112YUOtherREGENCE RIDER
WA0188446OtherL&I