Active NPI
Jordan D Young, D.M.D.
- Dentist
- Ridgefield, WA
National Provider Identifier
1841483302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00011193
- Practice address
- 109 S 65TH Ave Ste 104
Ridgefield, WA 98642-3708 - Phone
- (360) 887-2333
- NPI assigned
- Aug 19, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8952 | OR | |
| Dentist | 122300000X | DE00011193 | WA | Primary |
Addresses
Primary practice location
109 S 65TH Ave Ste 104
Ridgefield, WA 98642-3708
Mailing address
510 Allen St
Kelso, WA 98626-4139
Phone (360) 887-2333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160317001688 | WA | Order and Referring Only - Dentist | 1153628144 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8952 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458000000000",
"number": "1841483302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 ALLEN ST",
"city": "KELSO",
"state": "WA",
"postal_code": "986264139",
"telephone_number": "360-887-2333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 S 65TH AVE STE 104",
"city": "RIDGEFIELD",
"state": "WA",
"postal_code": "986423708",
"telephone_number": "360-887-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "JORDAN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-19",
"last_updated": "2016-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D8952",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00011193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgefield, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; 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.