Provider Demographics
NPI:1720060163
Name:YOUNKIN, ROBERT RAY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAY
Last Name:YOUNKIN
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 1:12040 NE 128TH ST
Mailing Address - Street 2:MS-10
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-3270
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:17000 140TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6928
Practice Address - Country:US
Practice Address - Phone:425-481-6363
Practice Address - Fax:425-488-4971
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA140338OtherLABOR & INDUSTRIES
WA8105207Medicaid
WA6402YOOtherBLUE SHIELD
WAP00108943OtherMEDICARE RAILROAD
WA8105207Medicaid
WAG8803963Medicare PIN
WAGAB40143Medicare PIN