Healthcare Provider Details

I. General information

NPI: 1710858287
Provider Name (Legal Business Name): DAMON SUEHIRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 CAMPUS DR STE A150
IRVINE CA
92612-2668
US

IV. Provider business mailing address

5 LEMON GRV
IRVINE CA
92618-4502
US

V. Phone/Fax

Practice location:
  • Phone: 949-509-9840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30315113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: