Provider Demographics
NPI:1124222724
Name:YOO, SONJA L (DO)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:L
Last Name:YOO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:11111 RESEARCH BLVD #475
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5283
Practice Address - Country:US
Practice Address - Phone:512-338-8181
Practice Address - Fax:512-338-8366
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0023005207V00000X
TXN2891207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2760535000OtherMYUTMB 2760535000-COMMERCIAL NUMBER
TX205014802Medicaid
TX205014803Medicaid
TX205014801Medicaid
TX8L18323Medicare PIN
TX8L18393Medicare PIN
TX205014802Medicaid