Provider Demographics
NPI:1841381704
Name:SU, LEONARD T (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:T
Last Name:SU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1135 116TH AVE NE STE 305
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:180-024-3585
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 250
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-453-1772
Practice Address - Fax:425-453-0603
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000452312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8481160Medicaid
WAG8866391Medicare PIN