Timothy Young, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

A41608 Issued in CA

Practice address

3400 Emerson St
Ste a
Clearlake, CA 95422-9529

Phone

(707) 995-4155

Fax

(707) 995-4158

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Marc R Shapiro Medical Corp

  • Internal Medicine Physician
  • Clearlake, CA
  • NPI 1235373184
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239926400000",
    "number": "1710984422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 EMERSON ST",
            "address_2": "STE A",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229529",
            "telephone_number": "707-995-4155",
            "fax_number": "707-995-4158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 EMERSON ST",
            "address_2": "STE A",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229529",
            "telephone_number": "707-995-4155",
            "fax_number": "707-995-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2009-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A41608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD #",
            "identifier": "080005029",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A416080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susanna Eileen Wright, LCSW, MSW, CADCI
• Raul Wybo-Gilbert
• Merrilyn Yang, PMHNP-BC
• Michelle Jia Jia Yang
• Dwayne Yee, FNP-BC
• Christina Ziehm, BCBA

• Ophthalmology Physician in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; 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.