Provider Demographics
NPI:1770553711
Name:YOUNG, CATHERINE O (DDS)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:O
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ELKHORN CT UNIT 409
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2386
Mailing Address - Country:US
Mailing Address - Phone:732-710-6499
Mailing Address - Fax:
Practice Address - Street 1:975 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1714
Practice Address - Country:US
Practice Address - Phone:650-480-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02129700122300000X
CADDS566391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038695Medicaid
BY8918899OtherD.E.A