Provider Demographics
NPI:1831106665
Name:JAYASINGHE, WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:JAYASINGHE
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 1:1930 WILSHIRE BLVD,
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3605
Mailing Address - Country:US
Mailing Address - Phone:213-483-2620
Mailing Address - Fax:213-483-7918
Practice Address - Street 1:679 S WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3505
Practice Address - Country:US
Practice Address - Phone:213-413-4141
Practice Address - Fax:213-484-6280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26210208200000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262100Medicaid
CAEMedicare UPIN