Provider Demographics
NPI:1982740049
Name:YOUNG, FRANK R (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:R
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 1:1510 S CENTRAL AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2578
Mailing Address - Country:US
Mailing Address - Phone:818-243-6597
Mailing Address - Fax:818-242-3628
Practice Address - Street 1:1510 S CENTRAL AVE STE 460
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2578
Practice Address - Country:US
Practice Address - Phone:818-243-6597
Practice Address - Fax:818-242-3628
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87987Medicare UPIN