Healthcare Provider Details

I. General information

NPI: 1821025537
Provider Name (Legal Business Name): JOHN ALGIS KUDIRKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

IV. Provider business mailing address

PO BOX 661147
ARCADIA CA
91066-1147
US

V. Phone/Fax

Practice location:
  • Phone: 805-370-4435
  • Fax: 805-379-5579
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG55914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: