Healthcare Provider Details

I. General information

NPI: 1841381704
Provider Name (Legal Business Name): LEONARD T SU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LN SUITE 250
KIRKLAND WA
98034-3099
US

IV. Provider business mailing address

1135 116TH AVE NE STE 305
BELLEVUE WA
98004-4623
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1772
  • Fax: 425-453-0603
Mailing address:
  • Phone: 180-024-3585
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD00045231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: