Irawan Susanto, MD
Internal Medicine, Critical Care Medicine in Santa Monica, CA. Individual provider (NPI-1).
Details
- NPI
- 1003836610
- Entity type
- Individual (NPI-1)
- Name
- Irawan Susanto
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 20, 2006
- Last updated
- Feb 6, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PULMONARY DISEASE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RC0200X | Internal Medicine, Critical Care Medicine | c50280 | CA | Yes |
| 207RP1001X | Internal Medicine, Pulmonary Disease | C50280 | CA |
Practice location
1223 16th StSuite 3400
Santa Monica, CA 90404-1217
Phone 310-449-0939 · Fax 424-259-7790
Mailing address
5767 W Century BlvdSuite 200
Los Angeles, CA 90045-5632
Phone 310-301-8708 · Fax 310-301-8751
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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