Provider Demographics
NPI:1679705750
Name:RONALD F YOUNG MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RONALD F YOUNG MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-816-8705
Mailing Address - Street 1:3400 W BALL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3738
Mailing Address - Country:US
Mailing Address - Phone:714-816-8705
Mailing Address - Fax:714-816-8707
Practice Address - Street 1:3400 W BALL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3738
Practice Address - Country:US
Practice Address - Phone:714-816-8705
Practice Address - Fax:714-816-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13272B207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13272BMedicaid
CA00G132720Medicaid
CAA38922Medicare UPIN