Provider Demographics
NPI:1427118751
Name:YOUNG, BENJAMIN BC (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BC
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:387 AUWINALA RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3434
Mailing Address - Country:US
Mailing Address - Phone:808-261-9959
Mailing Address - Fax:808-261-4540
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:#3306
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-779-6401
Practice Address - Fax:808-261-4540
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI32132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI038378-01Medicaid
HIH0000BDGJRMedicare ID - Type Unspecified