Provider Demographics
NPI:1053365700
Name:YOUNG, WESLEY K (MD)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:K
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1778 ALA MOANA BLVD
Mailing Address - Street 2:UL5
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1605
Mailing Address - Country:US
Mailing Address - Phone:808-955-5553
Mailing Address - Fax:808-955-5575
Practice Address - Street 1:1778 ALA MOANA BLVD
Practice Address - Street 2:UL5
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1605
Practice Address - Country:US
Practice Address - Phone:808-955-5553
Practice Address - Fax:808-955-5575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-4417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI010603Medicaid
HI010603Medicaid