Active NPI
Jathan Young, MD
- Pediatrics Physician
- Grapevine, TX
National Provider Identifier
1336830793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- W4239
- Practice address
- 1600 W College St
Grapevine, TX 76051-3580 - Phone
- (817) 488-7334
- NPI assigned
- May 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | W4239 | TX | Primary |
Addresses
Primary practice location
1600 W College St
Grapevine, TX 76051-3580
Mailing address
1600 W College St
Grapevine, TX 76051-3580
Phone (817) 488-7334
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230626001891 | MI | Order and Referring Only - Pediatric Medicine | 5890153704 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351050504 | MI | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783296000000",
"number": "1336830793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 W COLLEGE ST",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "760513580",
"telephone_number": "817-488-7334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 W COLLEGE ST",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "760513580",
"telephone_number": "817-488-7334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "JATHAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-17",
"last_updated": "2026-07-06",
"certification_date": "2026-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "W4239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grapevine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.