Active NPI
Craig M Young, MD
- Ophthalmology Physician
- Kent, WA
National Provider Identifier
1487647012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 0019725
- Practice address
- 24020 132ND Ave SE
Kent, WA 98042-5108 - Phone
- (253) 631-2929
- Fax
- (253) 631-2972
- NPI assigned
- Aug 30, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 0019725 | WA | Primary |
Addresses
Primary practice location
24020 132ND Ave SE
Kent, WA 98042-5108
Mailing address
24020 132ND Ave SE
Kent, WA 98042-5108
Phone (253) 631-2929
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1001718 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0019725 | WA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191196800000",
"number": "1487647012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24020 132ND AVE SE",
"city": "KENT",
"state": "WA",
"postal_code": "980425108",
"telephone_number": "253-631-2929",
"fax_number": "253-631-2972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24020 132ND AVE SE",
"city": "KENT",
"state": "WA",
"postal_code": "980425108",
"telephone_number": "253-631-2929",
"fax_number": "253-631-2972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "CRAIG",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-30",
"last_updated": "2007-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WA",
"license": "0019725",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1001718",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.