MEDICARE: DR. SOPHIA YENCHUAN KUO LEWIS MD

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	207R00000X	Internal Medicine Physician	2022012575	MO
2	208D00000X	General Practice Physician	2022012575	MO
3	208M00000X	Hospitalist Physician	2022012575	MO
4	207RI0200X	Infectious Disease Physician	A195468	CA
5	207R00000X	Internal Medicine Physician	A195468	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184249468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA YENCHUAN KUO LEWIS MD

Provider Business Mailing Address
First Line	:	PO BOX 60352
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63160-0352
Country	:	US
Telephone Number	:	314-362-5060
Fax Number	:	314-362-6959

Provider Business Practice Location Address
First Line	:	4901 FOREST PARK AVE
Second Line	:	DIV IM GENERAL MED, STE 241
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1495
Country	:	US
Telephone Number	:	314-362-5060
Fax Number	:	314-362-6959

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

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	06/15/2026

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