=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780913863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASOKA WIMALANANDA JAYASINGHE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2009
-----------------------------------------------------
Last Update Date | 12/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 W. TOWN & COUNTRY ROAD STE #51
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-542-7171
-----------------------------------------------------
Fax | 714-731-2929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 2126
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92859-0126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | AFE29520
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------