Provider Demographics
NPI:1922119916
Name:SOETIKNO, ROY MULJADI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:MULJADI
Last Name:SOETIKNO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2490 HOSPITAL DR STE 211
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4125
Mailing Address - Country:US
Mailing Address - Phone:650-492-3384
Mailing Address - Fax:650-963-3535
Practice Address - Street 1:2490 HOSPITAL DR STE 211
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4125
Practice Address - Country:US
Practice Address - Phone:650-492-3384
Practice Address - Fax:650-963-3535
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG76556207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology