Kaelan Dendy Young Black, M.D.

Primary specialty

Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X

License

0101263011 Issued in VA

Practice address

3801 University Dr Ste 300
Fairfax, VA 22030-2503

Phone

(703) 383-8130

Fax

(703) 383-7350

NPI assigned

Mar 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kaelan Dendy Young Former name

Medicare fee-for-service enrollment

Enrolled in DC, VA, OR3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Otolaryngology

Education

Georgetown University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Otolaryngology Associates PCGroup PAC ID 8022188069, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Otolaryngology Associates, PC

  • Otolaryngology Physician
  • Fairfax, VA
  • NPI 1861534836

  DC

  Medicare reassignment Care Compare group NPD
• Inova Health Care Services

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1952320061
  Medicare reassignment NPD
• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358
  Medicare reassignment NPD
• Otolaryngology Associates

  • Hearing Instrument Specialist
  • Fairfax, VA
  • NPI 1407996374
  NPD
• Legacy Emanuel Hospital & Health Center

  dba Apothecary at Emanuel Hospital

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1417977976
  NPD
• Legacy Emanuel Hospital & Health Center

  • Clinic/Center
  • Portland, OR
  • NPI 1700809027
  NPD
• Advanced Hearing Services

  • Hearing Aid Equipment
  • Fairfax, VA
  • NPI 1881022556
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1215226469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 UNIVERSITY DR",
            "address_2": "STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302503",
            "telephone_number": "703-383-8130",
            "fax_number": "703-383-7353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 UNIVERSITY DR STE 300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302503",
            "telephone_number": "703-383-8130",
            "fax_number": "703-383-7350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 N Graham St Ste 585",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271654",
            "country_code": "US",
            "telephone_number": "503-413-3690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KAELAN",
        "middle_name": "DENDY YOUNG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-28",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "OR",
            "license": "MD223309",
            "primary": false
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "VA",
            "license": "0101263011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAELAN",
            "last_name": "YOUNG",
            "middle_name": "DENDY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• BJS Wholesale Club Inc (BJS Pharmacy)
• Alison Black, D.O.
• Gloria Gilbert Black, CRNA
• Harold Micagah Black, CRNA
• Janet Elizabeth Black, M.ED., BCBA
• Steven Michael Black, LPC
• Allison Blackman, LPC
• Dion Marcellus Blackmon, L.AC
• Alice Blair
• David Blair, LMSW

• Pediatric Otolaryngology Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pediatric Otolaryngology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.