Basic Information
| Provider Information | |||||||||
| NPI: | 1720648884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOO | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | YOUNG IM | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 WOODLAND AVE APT 306 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170573082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706307877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 HIGHLANDS DR | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175437694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176255000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2019 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OT019511 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | OT019511 | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.