Basic Information
Provider Information
NPI: 1235166471
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOUNG
FirstName: JACK
MiddleName: CHIH-PIN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 GEORGE ST
Address2: PO BOX 9805
City: NEW HAVEN
State: CT
PostalCode: 065116624
CountryCode: US
TelephoneNumber: 2037857998
FaxNumber: 2037856414
Practice Location
Address1: 800 HOWARD AVE
Address2: YALE PHYSICIANS BLDG
City: NEW HAVEN
State: CT
PostalCode: 065191369
CountryCode: US
TelephoneNumber: 2037852140
FaxNumber: 2037856414
Other Information
ProviderEnumerationDate: 06/26/2006
LastUpdateDate: 11/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X04422CTY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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