Provider Demographics
NPI:1578198347
Name:YOUNG, ALESSANDRA R (DAC, DAOM)
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3533
Mailing Address - Country:US
Mailing Address - Phone:385-276-4537
Mailing Address - Fax:
Practice Address - Street 1:4434 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124-3533
Practice Address - Country:US
Practice Address - Phone:385-276-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11997127-1201171100000X
172853171100000X
CA18817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT119971271201OtherUTAH
NCC172853OtherNCCAOM
CA18817OtherCALIFORNIA ACUPUNCTURE BOARD
IDACU447OtherIDAHO