Provider Demographics
NPI:1982932042
Name:NA, YOUNG M (AC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:M
Last Name:NA
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2207
Mailing Address - Country:US
Mailing Address - Phone:218-382-1085
Mailing Address - Fax:213-382-1015
Practice Address - Street 1:2140 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2207
Practice Address - Country:US
Practice Address - Phone:218-382-1085
Practice Address - Fax:213-382-1015
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC6129OtherACUPUNCTURE