Provider Demographics
NPI:1992091748
Name:YOUNGSTROM, EDWIN ARTHUR (DO)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ARTHUR
Last Name:YOUNGSTROM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SAN DIMAS ST STE B231
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1494
Mailing Address - Country:US
Mailing Address - Phone:661-665-0505
Mailing Address - Fax:661-665-7844
Practice Address - Street 1:3838 SAN DIMAS ST STE B231
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1494
Practice Address - Country:US
Practice Address - Phone:661-665-0505
Practice Address - Fax:661-665-7844
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019533208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology