| Doctor Name: | IRAWAN SUSANTO |
| NPI Number: | 1003836610 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | C50280 |
| Business Practice Address: | 1223 16th St Suite 3400 Santa Monica, CA - 904041217 |
| Business Phone Number: | 3104490939 |
| Business Fax Number: | 4242597790 |
| Mailing Address: | 5767 W Century Blvd, Suite 200 LOS ANGELES |
| State: | CA |
| Postal Code: | 900455632 |
| Phone Number: | 3103018708 |
| Fax Number: | 3103018751 |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 02/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RP1001X |
| License Number: | C50280 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Pulmonary Disease |
| Taxonomy Definition: | An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |