Basic Information
| Provider Information | |||||||||
| NPI: | 1093924052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG-TRIPP | ||||||||
| FirstName: | SAWAR | ||||||||
| MiddleName: | CHALUTCH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YOUNG | ||||||||
| OtherFirstName: | SAWAR | ||||||||
| OtherMiddleName: | CHALUTCH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | ORLEANS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955560249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306273452 | ||||||||
| FaxNumber: | 5306273445 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 WEEOT WAY | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078255000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 155890 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD150077 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.