Individual
AGUSTINUS SUHARDJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101256807
VA
2085R0202X
Diagnostic Radiology Physician
04-34805
KS
2085R0202X
Diagnostic Radiology Physician
Primary
A89588
CA
2085R0202X
Diagnostic Radiology Physician
D0078407
MD
Other
Enumeration date
05/23/2007
Last updated
11/29/2021
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