Provider Demographics
NPI:1811025679
Name:SUZUKI, DANIEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1632
Mailing Address - Country:US
Mailing Address - Phone:626-403-8999
Mailing Address - Fax:626-403-8989
Practice Address - Street 1:2400 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1632
Practice Address - Country:US
Practice Address - Phone:626-403-8999
Practice Address - Fax:626-403-8989
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG566642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE49237Medicare UPIN
CAWG56664AMedicare PIN