Russell E Young, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8927 Issued in MN

Practice address

601 Jacob LN
Anoka, MN 55303

Phone

(763) 587-4400

Fax

(763) 587-4205

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1265407811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 34TH AVE S",
            "address_2": "21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251672",
            "telephone_number": "952-883-5790",
            "fax_number": "952-883-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JACOB LN",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "55303",
            "telephone_number": "763-587-4400",
            "fax_number": "763-587-4205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1833 2nd Ave",
            "address_2": "Mail Stop 39300A",
            "address_purpose": "LOCATION",
            "city": "Anoka",
            "state": "MN",
            "postal_code": "553032432",
            "country_code": "US",
            "telephone_number": "763-712-6000",
            "fax_number": "763-712-6475",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15245 Bluebird St NW",
            "address_purpose": "LOCATION",
            "city": "Andover",
            "state": "MN",
            "postal_code": "553043538",
            "country_code": "US",
            "telephone_number": "763-587-4688",
            "fax_number": "763-587-4662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "RUSSELL",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "8927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kia Yang
• Lao Yang
• Phakouew Yachai Yang, BA
• Sa Yang
• Salena Yang, PHARMD
• Mark Frederick Yseth, D.D.S.
• Jamie Zagaros
• Ann E. Zaiser, M.S. LP
• Olivia Zebro, D.C.
• Mackenzie Zimmerman, PA-C

• Physician Assistant in Anoka, MN
• Providers in Anoka, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.