Provider Demographics
NPI:1821037037
Name:YUNG, JEFFREY Y (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:Y
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 1:35 BILL FRIES DR BLDG L
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2797
Mailing Address - Country:US
Mailing Address - Phone:843-895-2140
Mailing Address - Fax:843-895-2141
Practice Address - Street 1:35 BILL FRIES DR BLDG L
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2797
Practice Address - Country:US
Practice Address - Phone:843-895-2140
Practice Address - Fax:843-598-2141
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001877213E00000X
SC725213ES0103X
MIJY001877213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD7255Medicaid
MI0F36418Medicare ID - Type Unspecified