Provider Demographics
NPI:1902025190
Name:YOUNG, STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
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 1:210 S. ELLSWORTH AVE, #745
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-888-2872
Mailing Address - Fax:
Practice Address - Street 1:50 S SAN MATEO DRIVE
Practice Address - Street 2:SUITE 380
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3865
Practice Address - Country:US
Practice Address - Phone:650-344-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22530207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22530OtherMEDICAL LICENSE
AY5090939OtherDEA
CAA22530OtherMEDICAL LICENSE
00A22530Medicare ID - Type Unspecified