KENNY SUSANTO (Credential# 2044193) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2021. The license status is ACTIVE.
KENNY SUSANTO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.065549-RES. The credential type is resident physician. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 1120 15th St, Augusta, GA 30912. The current status is active.
| Licensee Name | KENNY SUSANTO |
| Credential ID | 2044193 |
| Credential Number | 1.065549-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
1120 15th St Augusta GA 30912 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2020-07-01 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-05-12 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 2009135 | 1.065004 | Physician/Surgeon | 2020-03-09 | 2020-03-09 - 2020-12-31 | ACTIVE |
| Street Address | 1120 15th St |
| City | Augusta |
| State | GA |
| Zip Code | 30912 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Edwin D Joy Jr | Dept of Oral Surger, Augusta, GA 30912 | Dentist | 1997-04-14 ~ 1998-06-30 |
| Warren C Rivera-morales | School of Dentistry, Augusta, GA 30912 | Dentist | 1995-10-30 ~ 1996-10-31 |
| Veronica Solis | 1120 15th Street-ba 1411, Augusta, GA 30912 | Physician/surgeon | 2004-06-16 ~ 2004-08-31 |
| Carlos M Isales-forsythe | Medical College Ga, Augusta, GA 30912-3175 | Physician/surgeon | 1992-10-23 ~ 1993-12-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Family Planning Association of Maine Inc | 43 Gabriel Dr, Augusta, ME 04330-7852 | Public Charity | 2019-03-05 ~ 2020-05-31 |
| Charles W Jones | 1910 Thomas Ln, Augusta, GA 30904-5114 | Architect | 2020-08-01 ~ 2021-07-31 |
| June Yowtak | 2095 Willhaven Dr, Augusta, GA 30909 | Resident Physician | 2017-07-07 ~ 2021-06-30 |
| Amd Medicom Inc | 4049 Allen Station Rd Ste A, Augusta, GA 30906-8734 | Wholesaler of Drugs, Cosmetics & Medical Devices | 2020-07-01 ~ 2021-06-30 |
| Augusta Medical Systems LLC | 1027 Broad St, Augusta, GA 30901-1142 | Wholesaler of Drugs, Cosmetics & Medical Devices | 2020-07-01 ~ 2021-06-30 |
| Elizabeth B Eubanks | 2829 Lombardy Ct, Augusta, GA 30909-3901 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Yumeris De Jesus Baez | 2803 Ridgecrest Dr, Augusta, GA 30907-4821 | Registered Nurse | ~ |
| Carrie Lynn Wimer | 165 Queen Dr, Augusta, WV 26704-7643 | Registered Nurse - Temporary | 2020-04-30 ~ 2020-08-28 |
| Richard J Raskin | 15 Enterprise Dr, Augusta, ME 04330-7997 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Glenn A Calabrese | 2 Grant Ct, Augusta, NJ 07822-2158 | Asbestos Consultant-inspector | 2020-03-01 ~ 2021-02-28 |
| Find all Licenses in Augusta | |||
| City | Augusta |
| Zip Code | 30912 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + Augusta |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| James T Kenny · Kenny Painting and Restoration | 24 Hartford Ave, Greenwich, CT 06830 | Home Improvement Contractor | 1998-03-27 ~ 1998-11-30 |
| Marie Kenny-matava · Kenny | 43 Taylor St, Torrington, CT 06790 | Hairdresser/cosmetician | 2018-10-01 ~ 2020-09-30 |
| Kenny's Oil LLC | 278 Old Poverty Rd, Southbury, CT 06488-1769 | Home Heating Fuel Dealer | 2019-10-01 ~ 2020-09-30 |
| Susan L Kenny · Kenny | 163 Newmarker Rd, South Windsor, CT 06074 | Radiographer | 2020-08-01 ~ 2021-07-31 |
| Douglas Kenny · The D J Kenny Company | Po Box 1072, Glastonbury, CT 06033-6072 | Home Improvement Contractor | 2014-12-01 ~ 2015-11-30 |
| Kenneth G Grant · Kenny G Pub | 171 Quinnipiac Street, Wallingford, CT 06492 | Cafe Liquor | 1998-11-27 ~ 1999-11-26 |
| Paul A Kenny · Kenny Painting | 78 Pratt St, Glastonbury, CT 06033 | Home Improvement Contractor | 2019-12-01 ~ 2020-11-30 |
| Kenneth J Guerra · Kenny Gs | 1536 Whalley Avenue, New Haven, CT 06515 | Restaurant Liquor | 1999-08-16 ~ 2000-08-15 |
| Cara E Kenny · Kenny | Po Box 555, Ashfield, MA 01330 | Registered Nurse | 2012-07-01 ~ 2013-06-30 |
| Kenny Pylant Builders Inc | 4 Maryland Ave, Armonk, NY 10504 | Home Improvement Contractor | 2001-12-01 ~ 2002-11-30 |
Please comment or provide details below to improve the information on KENNY SUSANTO.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).