Didik Suhardjo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

48030 Issued in CA

Practice address

749 S Union Ave
Los Angeles, CA 90017-2115

Phone

(213) 483-5616

Fax

(213) 483-5633

NPI assigned

Jul 21, 2006

Last updated

May 14, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368489600000",
    "number": "1427078211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 S UNION AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172115",
            "telephone_number": "213-483-5616",
            "fax_number": "213-483-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 S UNION AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172115",
            "telephone_number": "213-483-5616",
            "fax_number": "213-483-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUHARDJO",
        "first_name": "DIDIK",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2013-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D48030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Allen Suh, MD
• Susana Suh
• Timothy Suh
• Young Il Suh
• Young Seok Suh, M.D.
• Claire Suisman, MA, APCC
• William G Sujan, BS, MS, MBA
• Sujin Jeon Licensed Clinical Social Worker, Inc
• Suk B Hong Chiropractic Inc (Healing Chiropractic Clinic)
• Kwang Soo Suk, LAC

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.