Provider Demographics
NPI:1194236109
Name:YOUNAN, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YOUNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DAYBREAK DR APT G
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-4205
Mailing Address - Country:US
Mailing Address - Phone:951-314-5875
Mailing Address - Fax:
Practice Address - Street 1:MINISTRY HEALTH
Practice Address - Street 2:MULLEA CLININC
Practice Address - City:OMAN
Practice Address - State:OMAN
Practice Address - Zip Code:31400
Practice Address - Country:OM
Practice Address - Phone:951-314-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-417246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant