Provider Demographics
NPI:1043272487
Name:HAJDUCZEK, ANDREW JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAN
Last Name:HAJDUCZEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1536 W 25TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4415
Mailing Address - Country:US
Mailing Address - Phone:310-213-5484
Mailing Address - Fax:310-326-3744
Practice Address - Street 1:1536 W 25TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4415
Practice Address - Country:US
Practice Address - Phone:310-213-5484
Practice Address - Fax:310-326-3744
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41573208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A415731Medicaid
CAA41573AMedicare PIN
CA00A415731Medicaid