IndividualActive
Agustinus Suhardja, MD
NPI 1235349473 · Diagnostic Radiology Physician · Glendora, CA
Provider details
- NPI number
- 1235349473
- Entity type
- Individual
- Primary specialty
- Diagnostic Radiology PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 04-34805 (KS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
828 S Grand Ave Ste 104
Glendora, CA 91740-4856
Phone: (626) 963-2057
Fax: (626) 963-4298
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 6869
Orange, CA 92863-6869
Registry dates
- Enumerated
- 2007-05-23
- Last updated
- 2021-11-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.