Provider Demographics
NPI:1801924477
Name:WALTER JAYASINGHE MD APC
Entity type:Organization
Organization Name:WALTER JAYASINGHE MD APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO,COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HITESHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-483-2620
Mailing Address - Street 1:2010 WILSHIRE BLVD
Mailing Address - Street 2:#2000
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3507
Mailing Address - Country:US
Mailing Address - Phone:213-353-1555
Mailing Address - Fax:213-483-7918
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:#2000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3507
Practice Address - Country:US
Practice Address - Phone:213-353-1555
Practice Address - Fax:213-483-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43505207Q00000X
CAA26210207VG0400X
CAA389780208000000X
CAPA15310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0004060Medicaid