Healthcare Provider Details

I. General information

NPI: 1356575625
Provider Name (Legal Business Name): ANDRZEJ BULCZYNSKI M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 GLENCOE AVE # 145
MARINA DEL REY CA
90292-6385
US

IV. Provider business mailing address

4551 GLENCOE AVE # 145
MARINA DEL REY CA
90292-6385
US

V. Phone/Fax

Practice location:
  • Phone: 310-574-0383
  • Fax: 310-724-8188
Mailing address:
  • Phone: 310-574-0383
  • Fax: 310-724-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA89040
License Number StateCA

VIII. Authorized Official

Name: DR. ANDRZEJ BULCZYNSKI
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 310-574-0400