Provider Demographics
NPI:1700125127
Name:WALTER JAYASINGHE M.D. A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:WALTER JAYASINGHE M.D. A PROFESSIONAL CORP
Other - Org Name:LOS ANGELES MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYASINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-483-2620
Mailing Address - Street 1:200 S BEACH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5180
Mailing Address - Country:US
Mailing Address - Phone:562-267-1321
Mailing Address - Fax:562-697-3009
Practice Address - Street 1:200 S BEACH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5180
Practice Address - Country:US
Practice Address - Phone:562-267-1321
Practice Address - Fax:562-697-3009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER JAYASINGHE M.D. A PROFESSIONAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31911207Q00000X, 207R00000X
CAA26210207VG0400X
CAPA20052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid