Provider Demographics
NPI:1538176060
Name:DESILVA, ARUMAKANKANI JAYALATH (MD)
Entity type:Individual
Prefix:
First Name:ARUMAKANKANI
Middle Name:JAYALATH
Last Name:DESILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S LAKE AVE
Mailing Address - Street 2:535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:51 N. FIFTH AVENUE
Practice Address - Street 2:101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91106-3739
Practice Address - Country:US
Practice Address - Phone:626-471-9901
Practice Address - Fax:626-471-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31831207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318310OtherBLUE SHIELD
CA00A318310Medicaid
CA00A318310OtherBLUE SHIELD
CAW18420Medicare ID - Type Unspecified