Healthcare Provider Details

I. General information

NPI: 1568524726
Provider Name (Legal Business Name): IGNATIUS SUKAMTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10808 RAMONA BLVD
EL MONTE CA
91731-2628
US

IV. Provider business mailing address

1041 MOONBEAM DR
MONTEREY PARK CA
91754-5229
US

V. Phone/Fax

Practice location:
  • Phone: 626-579-6277
  • Fax: 626-579-6739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 35336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: