Individual
DARYL SUDASENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
406 BLACK HILLS LN SW, OLYMPIA, WA 98502-8143
(360) 754-1735
Mailing address
406 BLACK HILLS LN SW, OLYMPIA, WA 98502-8143
(360) 754-1735
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R9445
TX
207RC0000X
Cardiovascular Disease Physician
307858
NY
207RI0011X
Interventional Cardiology Physician
Primary
MD61145791
WA
Other
Enumeration date
04/01/2014
Last updated
05/03/2022
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