Provider Demographics
NPI:1376569517
Name:SUZUKI, SHUICHI (MD)
Entity Type:Individual
Prefix:
First Name:SHUICHI
Middle Name:
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VERNAL SPG
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0405
Mailing Address - Country:US
Mailing Address - Phone:714-943-3788
Mailing Address - Fax:949-737-1101
Practice Address - Street 1:1015 NORTH 1ST AVE. SUITE A
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-566-2866
Practice Address - Fax:626-566-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA724432084N0400X, 2084V0102X
TXFTL 419712085N0700X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192474803OtherCSHCN
TX8AL151OtherBCBS
TX192474802Medicaid
CA00AA72443Medicaid
CA00AA72443Medicaid
CAA72443Medicare ID - Type Unspecified
TX8AL151OtherBCBS