Susanto, Irawan

Susanto, Irawan is an individual health care provider with primary practice located at 1223 16Th St Suite 3400, Santa Monica CA 90404-1217. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pulmonary Disease, Allopathic & Osteopathic Physicians / Critical Care Medicine. Allopathic & Osteopathic Physicians / Critical Care Medicine is his primary health care specialty. Susanto, Irawan can be contacted via phone (310) 449-0939.

Contact Information

Primary practice address
1223 16Th St Suite 3400 Santa Monica CA 90404-1217
Phone: (310) 449-0939
Fax: (424) 259-7790
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X C50280 California
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X C50280 California

Profile Details

NPI number 1003836610
LBN Legal business name Susanto, Irawan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2006
Last updated Feb 6th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003836610 NPPES
California MEDICAID 00C502800

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