Healthcare Provider Details

I. General information

NPI: 1063453306
Provider Name (Legal Business Name): KRZYSZTOF M KUCZKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DRIVE UCSD MEDICAL CENTER MC 0801
SAN DIEGO CA
92103-0801
US

IV. Provider business mailing address

8720 VILLA LA JOLLA DR
LA JOLLA CA
92037-1920
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5720
  • Fax:
Mailing address:
  • Phone: 858-638-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA73507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: