Healthcare Provider Details

I. General information

NPI: 1831106665
Provider Name (Legal Business Name): WALTER JAYASINGHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S WESTLAKE AVE
LOS ANGELES CA
90057-3505
US

IV. Provider business mailing address

1930 WILSHIRE BLVD, SUITE 1100
LOS ANGELES CA
90057-3605
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-4141
  • Fax: 213-484-6280
Mailing address:
  • Phone: 213-483-2620
  • Fax: 213-483-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA26210
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA26210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: