Healthcare Provider Details

I. General information

NPI: 1457460503
Provider Name (Legal Business Name): JAYASINGHE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N SOTO ST
LOS ANGELES CA
90033-1837
US

IV. Provider business mailing address

1930 WILSHIRE BLVD
LOS ANGELES CA
90057-3605
US

V. Phone/Fax

Practice location:
  • Phone: 323-266-6730
  • Fax: 323-266-6750
Mailing address:
  • Phone: 213-483-2620
  • Fax: 213-483-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14957
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15310
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN349926
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER JAYASINGHE
Title or Position: OWNER
Credential: M.D.
Phone: 213-483-2620