Healthcare Provider Details

I. General information

NPI: 1689484347
Provider Name (Legal Business Name): KEIJI SUZUYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 GILBERT ST
NORFOLK VA
23511-2914
US

IV. Provider business mailing address

2229 WALL ST
EAGAN MN
55122-4046
US

V. Phone/Fax

Practice location:
  • Phone: 612-562-5011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: