Provider Demographics
NPI:1619986726
Name:HAJDUCZKI, ISTVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ISTVAN
Middle Name:
Last Name:HAJDUCZKI
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 1:527 DELAWARE RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4038
Mailing Address - Country:US
Mailing Address - Phone:818-559-7635
Mailing Address - Fax:323-466-9696
Practice Address - Street 1:7060 HOLLYWOOD BLVD
Practice Address - Street 2:406
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6009
Practice Address - Country:US
Practice Address - Phone:323-466-9696
Practice Address - Fax:323-466-6706
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51485174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF84260Medicare UPIN
CAA51485Medicare ID - Type Unspecified