Provider Demographics
NPI:1659361400
Name:YOUNG, JERALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:A
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 1:2 BON AIR RD
Mailing Address - Street 2:#100
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-927-6158
Mailing Address - Fax:415-927-6168
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:#100
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-927-6158
Practice Address - Fax:415-927-6168
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-02-08
Deactivation Date:2020-12-21
Deactivation Code:
Reactivation Date:2021-02-08
Provider Licenses
StateLicense IDTaxonomies
CAC31446207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34580Medicare UPIN