Provider Demographics
NPI:1588771273
Name:YOUNG, KATHERINE Y (DPM)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:Y
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:3925 GLEN ABBY CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1802
Mailing Address - Country:US
Mailing Address - Phone:209-952-1612
Mailing Address - Fax:209-952-1631
Practice Address - Street 1:1810 GRAND CANAL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8110
Practice Address - Country:US
Practice Address - Phone:209-952-1612
Practice Address - Fax:209-952-1631
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE3251213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery