MEDICARE: JOHN JAMES KOWALCZYK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	20A6818	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340018768	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548254089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JAMES KOWALCZYK DO

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 805
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3909
Country	:	US
Telephone Number	:	213-977-1176
Fax Number	:	213-977-0668

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 805
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-977-1176
Fax Number	:	213-977-0668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	11/22/2022

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Directions to “ JOHN JAMES KOWALCZYK DO” Practice Location

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