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Organization
TAHOE CARSON VALLEY MEDICAL GROUP INC
Active
Organization
TAHOE CARSON VALLEY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID YOUNG MD (PRESIDENT)
(775) 589-8916
Entity
Organization
Contact information
Practice address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150
(530) 541-3420
(530) 541-8723
Mailing address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7026
(530) 543-5659
(530) 541-8723
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506149
—
NV
05
—
100506911
—
CA
05
—
GR0055020
—
CA
05
—
GR0055021
—
CA
05
—
GR0055022
—
CA
05
—
GR0055023
—
CA
01
—
USA292950
BLUE SHIELD OF CA
CA
01
—
USA292960
BLUE SHIELD OF CA
CA
01
—
USA292970
BLUE SHIELD OF CA
CA
01
—
USA293170
BLUE SHIELD OF CA
CA
01
—
USA293250
BLUE SHIELD OF CA
CA
05
—
XGG007610
—
CA
05
—
XGG007611
—
CA
05
—
XGG007612
—
CA
01
—
ZZZ14014Z
BLUE SHIELD OF CA
CA
01
—
ZZZ54133Z
BLUE SHIELD OF CA
CA
01
—
ZZZ61294Z
BLUE SHIELD OF CA
CA
01
—
ZZZ65882Z
BLUE SHIELD OF CA
CA
Enumeration date
07/20/2005
Last updated
07/29/2026
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