Provider Demographics
NPI:1740492271
Name:YOUNGER, JARED RONALD (MD, MPH)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:RONALD
Last Name:YOUNGER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18426 BROOKHURST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6776
Mailing Address - Country:US
Mailing Address - Phone:714-546-2020
Mailing Address - Fax:
Practice Address - Street 1:18426 BROOKHURST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6776
Practice Address - Country:US
Practice Address - Phone:714-546-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99514207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A995140Medicaid
CAW22487Medicare PIN
CA0462890001Medicare NSC
CAWA99514AMedicare PIN