Provider Demographics
NPI:1295380525
Name:YOUNG, CLIFFORD S
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W HUNTINGTON DR STE 217
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-1529
Mailing Address - Country:US
Mailing Address - Phone:626-445-2536
Mailing Address - Fax:
Practice Address - Street 1:301 W HUNTINGTON DR STE 217
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1529
Practice Address - Country:US
Practice Address - Phone:626-484-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist