Healthcare Provider Details

I. General information

NPI: 1255547493
Provider Name (Legal Business Name): NIKOLAI ALEXANDER BILDZUKEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SUNNY CREST DR STE 2500
FULLERTON CA
92835-3644
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 714-263-9383
  • Fax:
Mailing address:
  • Phone: 323-442-9062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA82509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: