Individual provider · Type 1 NPI

Kezia Ivanka Surjanto, MD

Student in an Organized Health Care Education/Training Program · Palo Alto, CA

NPI number 1558066308 Active

Practice location

780 Welch Rd Rm CJ220F
Palo Alto, CA 94304-1516

Call (650) 796-3912 Map

Mailing address

1430 Tulane Ave # 8050
New Orleans, LA 70112-2632

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1558066308

Kezia Ivanka Surjanto, MD's National Provider Identifier is 1558066308, issued on Apr 3, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Palo Alto, CA. The record was last updated on Jun 20, 2024.