Provider Demographics
NPI:1639783194
Name:KANISHKA WIJEGUNARATNE, MD INC
Entity Type:Organization
Organization Name:KANISHKA WIJEGUNARATNE, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANISHKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIJEGUNARATNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-928-9927
Mailing Address - Street 1:16837 SHILENO PL
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3534
Mailing Address - Country:US
Mailing Address - Phone:714-928-9927
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 504
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4633
Practice Address - Country:US
Practice Address - Phone:310-477-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty