Susanto, Daniel
Susanto, Daniel is an individual health care provider with primary practice located at 19020 33Rd Ave W Ste 210 , Lynnwood WA 98036-4748. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Neuroradiology. Allopathic & Osteopathic Physicians / Neuroradiology is his primary health care specialty. Susanto, Daniel can be contacted via phone (425) 563-1500.Contact Information
Primary practice address
19020 33Rd Ave W Ste 210
Lynnwood WA 98036-4748
Phone: (425) 563-1500
Fax: (425) 563-1501
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 17687 | Minnesota |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | MD60083485 | Washington |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | S-7900 | Alaska |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | M-12378 | Idaho |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | MD60083485 | Washington |
Profile Details
| NPI number | 1144364605 |
|---|---|
| LBN Legal business name | Susanto, Daniel |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 17th, 2007 |
| Last updated | Nov 5th, 2019 - about 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144364605 | NPPES |
| Idaho | MEDICAID | 1144364605 | |
| Idaho | Other | 263299 | |
| Idaho | MEDICAID | 1584895 | |
| Idaho | Other | 263302 | |
| Idaho | Other | 263305 | |
| Idaho | MEDICAID | 2007663 |
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