Healthcare Provider Details

I. General information

NPI: 1548122724
Provider Name (Legal Business Name): ANULA KUSUM JAYASURIYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26010 TORELLO LN
LOS ALTOS HILLS CA
94022-2094
US

IV. Provider business mailing address

26010 TORELLO LN
LOS ALTOS HILLS CA
94022-2094
US

V. Phone/Fax

Practice location:
  • Phone: 650-224-2002
  • Fax:
Mailing address:
  • Phone: 650-224-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG79484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: