Provider Demographics
NPI:1790001568
Name:YOUNG, YAVARACE (MD)
Entity Type:Individual
Prefix:
First Name:YAVARACE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YAVARACE
Other - Middle Name:
Other - Last Name:VONGSIVAVILAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1055 WELLINGTON WAY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1259
Mailing Address - Country:US
Mailing Address - Phone:859-219-2828
Mailing Address - Fax:859-219-0524
Practice Address - Street 1:624 CHAMBERLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4220
Practice Address - Country:US
Practice Address - Phone:502-227-2285
Practice Address - Fax:502-227-1465
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18482207Q00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology