DANIEL SUSANTO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036150212

License Status

ACTIVE

Business

Title

First Name

DANIEL

Last Name

SUSANTO

Business Name

DANIEL SUSANTO MD

Original Issue Date

07/15/2019

Effective Date

07/14/2023

Expiration Date

07/31/2026

City

LYNWOOD

State

Zip

98036

Ever Disciplined

LastModifiedDate

07/14/2023