Healthcare Provider Details

I. General information

NPI: 1861870545
Provider Name (Legal Business Name): TAISEI SUZUKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 KENILWORTH TER NE
WASHINGTON DC
20019-1898
US

IV. Provider business mailing address

765 KENILWORTH TER NE
WASHINGTON DC
20019-1898
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8160
  • Fax: 202-548-8600
Mailing address:
  • Phone: 202-469-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO034756
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: