Provider Demographics
NPI:1538177811
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: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 1:1930 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43505207Q00000X
CAA26210207V00000X
CAA29540207V00000X
CAPA13399363A00000X
CAPA14988363A00000X
CAPA14957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0004066Medicaid