Provider Demographics
NPI:1972246734
Name:YUCELEN, SUMEYRA YILDIRIM (MD)
Entity type:Individual
Prefix:DR
First Name:SUMEYRA
Middle Name:YILDIRIM
Last Name:YUCELEN
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 1:56 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:949-630-8594
Mailing Address - Fax:
Practice Address - Street 1:1010 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5929
Practice Address - Country:US
Practice Address - Phone:310-406-8220
Practice Address - Fax:310-376-8228
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT06-0646844390200000X
CAA202963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program