Healthcare Provider Details

I. General information

NPI: 1972246734
Provider Name (Legal Business Name): SUMEYRA YILDIRIM YUCELEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200B200D
NEWPORT BEACH CA
92663-3663
US

IV. Provider business mailing address

56 FRANKLIN ST
WATERBURY CT
06706-1253
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3001
  • Fax: 949-791-3096
Mailing address:
  • Phone: 949-630-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number06-0646844
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA202963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: