Provider Demographics
NPI:1639490402
Name:DJURDJULOV, ADAM VOJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:VOJIN
Last Name:DJURDJULOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 515412
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-6712
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5438
Practice Address - Fax:949-764-5674
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPIT # BP10038241207L00000X
CAA118099207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology