Provider Demographics
NPI:1326834912
Name:YOUNG, KARLEY M (RD)
Entity type:Individual
Prefix:
First Name:KARLEY
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 THORP SPG
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1344
Mailing Address - Country:US
Mailing Address - Phone:949-632-2006
Mailing Address - Fax:
Practice Address - Street 1:4 THORP SPG
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1344
Practice Address - Country:US
Practice Address - Phone:949-632-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA889189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered