Provider Demographics
NPI:1780712398
Name:GRACE YOUNG, M.D., INC.
Entity type:Organization
Organization Name:GRACE YOUNG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-817-7878
Mailing Address - Street 1:836 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6836
Mailing Address - Country:US
Mailing Address - Phone:714-277-4123
Mailing Address - Fax:714-277-4063
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:STE 104
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-817-7878
Practice Address - Fax:714-277-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37579Medicare ID - Type UnspecifiedPROVIDER NUMBER