Provider Demographics
NPI:1972762797
Name:LEU, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:LEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-505-1300
Mailing Address - Fax:
Practice Address - Street 1:1909 214TH ST SE STE 300
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4418
Practice Address - Country:US
Practice Address - Phone:206-505-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60276073207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA121574OtherMEDICAL BOARD OF CALIFORNIA
HIMD16129OtherSTATE LICENSE
WAMD60276073OtherWASHINGTON STATE DEPARTMENT OF HEALTH