Irawan Susanto MD

NPI 1003836610 - Internal Medicine - 207RP1001X

NPI Details
NPI 1003836610
Gender Male
Enumeration Date 07/20/2006
Last Updated 02/06/2014
Entity Type Individual
Active Over 11 years ago
Practice Location
1223 16TH ST
SUITE 3400
SANTA MONICA CA, 90404-1217, US
Phone (310) 449-0939
Fax (424) 259-7790
Business Location
LOS ANGELES CA, 90045-5632, US
Phone (310) 301-8708
Fax (310) 301-8751
Taxonomy Code 207RP1001X
License State California
License Number C50280
Remove 1003836610 NPI Number

According to our database, Irawan Susanto MD NPI is 1003836610, taxonomy code is 207RP1001X and license number is C50280, license state is located at California. Irawan Susanto MD physically located at 1223 16th St, Santa Monica CA, 90404-1217. NPI Number Irawan Susanto MD has the Individual type.

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1003836610 NPI number is provided on an as is basis without warranty of any kind. 1003836610 is maintained by the National Plan & Provider Enumeration System. The contents of Irawan Susanto MD are for informational purposes only.