MEDICARE: DR. SOPHIA YUAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2015-01825	NC
2	2084P0800X	Psychiatry Physician	201501825	NC

General Provider Information

NPI Number	:	1700152915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA YUAN M.D.

Provider Business Mailing Address
First Line	:	2235 LEWISVILLE CLEMMONS RD STE A
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2554 LEWISVILLE CLEMMONS RD STE 209
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8749
Country	:	US
Telephone Number	:	336-660-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	01/17/2020

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