Healthcare Provider Details

I. General information

NPI: 1578562740
Provider Name (Legal Business Name): SUSAN HEEWON SNYDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN H LEE MD

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S BATAVIA ST STE. 103
ORANGE CA
92868-3936
US

IV. Provider business mailing address

PO BOX 14005
ORANGE CA
92863-1405
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-6731
  • Fax: 714-771-8369
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG73608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: