Basic Information
| Provider Information | |||||||||
| NPI: | 1124298906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | CASPER | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20750 VENTURA BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913646235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104778051 | ||||||||
| FaxNumber: | 3108439662 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 BALBOA BLVD STE 111 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913165206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187848975 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2008 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 20A9358 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.