Provider Demographics
NPI:1447287834
Name:KEUNSUN LEW MD INC
Entity type:Organization
Organization Name:KEUNSUN LEW MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-281-4959
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:1109 EASTERN AVE
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-0769
Mailing Address - Country:US
Mailing Address - Phone:419-281-4959
Mailing Address - Fax:419-281-8767
Practice Address - Street 1:24 E WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1282
Practice Address - Country:US
Practice Address - Phone:419-281-4959
Practice Address - Fax:419-281-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386989Medicaid
OH0386989Medicaid