Provider Demographics
NPI:1487187894
Name:YUEN, SONIA (MD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:YUEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NAVARRE PL STE 4460
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1168
Mailing Address - Country:US
Mailing Address - Phone:574-235-1010
Mailing Address - Fax:574-232-2064
Practice Address - Street 1:100 NAVARRE PL STE 4460
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1168
Practice Address - Country:US
Practice Address - Phone:574-235-1010
Practice Address - Fax:574-232-2064
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.030066207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300043507Medicaid