Provider Demographics
NPI:1053378018
Name:HO, SANTOSA (MD)
Entity type:Individual
Prefix:
First Name:SANTOSA
Middle Name:
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5014
Mailing Address - Country:US
Mailing Address - Phone:360-659-4141
Mailing Address - Fax:360-659-1712
Practice Address - Street 1:1602 4TH STREET
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5014
Practice Address - Country:US
Practice Address - Phone:360-659-4141
Practice Address - Fax:360-659-1712
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
81109OtherL & I
WA1091917Medicaid
F93708Medicare UPIN