Most Relevant Information
Provider Data
| NPI Number: | 1003836610 |
| Provider Name: | IRAWAN SUSANTO MD |
| Entity Type: | Individual |
| Taxonomy Code: | 207RP1001X |
| Specialty: | Internal Medicine |
| License Number: | C50280 |
Most Important Dates
| Enumeration Date: | 07/20/2006 |
| Last Updated: | 02/06/2014 |
Provider Practice Location
1223 16TH ST
SUITE 3400
SANTA MONICA
CA
904041217
Practice Location Phone/Fax
| Phone: | 3104490939 |
| Fax: | 4242597790 |
Provider Mailing Location
5767 W CENTURY BLVD
SUITE 200
LOS ANGELES
CA
900455632
Provider Mailing Phone/Fax
| Phone: | 3103018708 |
| Fax: | 3103018751 |
Suggested EMR
Pulmonologist EMR