Healthcare Provider Details

I. General information

NPI: 1972762797
Provider Name (Legal Business Name): SUSAN LEU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE STE 300
BOTHELL WA
98021-4418
US

IV. Provider business mailing address

1200 12TH AVE S
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-505-1300
  • Fax:
Mailing address:
  • Phone: 206-505-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60276073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: