Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD-19180 | HI |
N | 207N00000X | Dermatologist | MD176186 | OR |
N | 207ND0900X | Dermatopathologist | 15757 | NV |
NPI | 1619276177 |
---|---|
Provider Name | Dr. Jason W. Suszko |
First Address | Honolulu, HI 96814-2118 |
Second Address | Honolulu, HI 96814-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 27/05/2021 |