Individual
DR. DANIEL SUSANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1501
Mailing address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
MD60083485
WA
2085R0202X
Diagnostic Radiology Physician
17687
MN
2085R0202X
Diagnostic Radiology Physician
M-12378
ID
2085R0202X
Diagnostic Radiology Physician
MD60083485
WA
2085R0202X
Diagnostic Radiology Physician
S-7900
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144364605
—
ID
05
—
1584895
—
AK
05
—
2007663
—
WA
01
—
263299
LNI
WA
01
—
263302
LNI
WA
01
—
263305
LNI
WA
Enumeration date
02/17/2007
Last updated
02/11/2026
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