Provider Demographics
NPI:1528502051
Name:YOUNG, DENNIS JR (MMT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 SANTA MONICA AVE UNIT 7840
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4833 SANTA MONICA AVE UNIT 7840
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2810
Practice Address - Country:US
Practice Address - Phone:760-401-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72368OtherMEDICAL MASSAGE CERT
CA73268OtherCALIFORNIA MASSAGE THERAPY COUNCIL