Provider Demographics
NPI:1447324850
Name:YOUNG, EDWARD M JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3710 SO ROBERTSON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2347
Mailing Address - Country:US
Mailing Address - Phone:310-202-6204
Mailing Address - Fax:310-202-0831
Practice Address - Street 1:5204 MELVIN AVENUE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3805
Practice Address - Country:US
Practice Address - Phone:818-343-6653
Practice Address - Fax:818-343-6683
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-04-19
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Provider Licenses
StateLicense IDTaxonomies
CAG045532207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE87044Medicare UPIN
CAG045532Medicare ID - Type Unspecified
CAE17044Medicare UPIN
CAG45532Medicare PIN