Basic Information
| Provider Information | |||||||||
| NPI: | 1104265677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | JUSTINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 N BRAND BLVD STE 1400 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912034263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188395200 | ||||||||
| FaxNumber: | 8188443887 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 W BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906404308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237261222 | ||||||||
| FaxNumber: | 8188443887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 20A13841 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.