Provider Demographics
NPI:1578562740
Name:SNYDER, SUSAN HEEWON (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HEEWON
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:H
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 14005
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-1405
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:431 S BATAVIA ST
Practice Address - Street 2:STE. 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3936
Practice Address - Country:US
Practice Address - Phone:714-538-6731
Practice Address - Fax:714-771-8369
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG736082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
053304CG04261OtherTRAILBLAZER
00G736080OtherBLUE SHIELD OF CA
300084918OtherRAILROAD MEDICARE
00G736080 159OtherCALOPTIMA
CA00G736080Medicaid
00G736080 159OtherCALOPTIMA
WG73608RMedicare PIN
G04261Medicare UPIN
WG73608SMedicare PIN
WG73608QMedicare PIN