Provider Demographics
NPI:1720492820
Name:YOUNG, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
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 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:7000 SW REDWOOD LN
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7134
Practice Address - Country:US
Practice Address - Phone:503-210-9150
Practice Address - Fax:503-210-1895
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155530207WX0009X
390200000X
ORMD193169207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program