IWAN SUGIHARTO NYOTOWIDJOJO MD Medical Doctor License verification

IWAN SUGIHARTO NYOTOWIDJOJO MD

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036163330

License Status

ACTIVE

Business

Title

First Name

IWAN

Middle

SUGIHARTO

Last Name

NYOTOWIDJOJO

Business Name

IWAN SUGIHARTO NYOTOWIDJOJO MD

Original Issue Date

01/05/2023

Effective Date

07/26/2023

Expiration Date

07/31/2026

City

IRVINE

State

Zip

92618

Ever Disciplined

LastModifiedDate

05/21/2025

Case Number

2025002614

Action

Suspension

Discipline Start Date

05/16/2025

Discipline Reason

physician and surgeon license automatically and indefinitely suspended for the suspension of his compact licensure in the State of Principal Licensure, Colorado pursuant to 45 ILCS 180/5(10)(b).