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NPI Code Detail

MEDICARE: DR. JYOTIKA L WALI M.D.

MEDICARE: DR. JYOTIKA L WALI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician45629CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2EQ451ZOTHERCAMEDICARE ID - GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134195118
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JYOTIKA L WALI M.D.
Provider Business Mailing Address
First Line : 1001 E CHAPMAN AVE
Second Line : SUITE D
City : FULLERTON
State : CA
Zip : 92831-3811
Country : US
Telephone Number : 714-451-0000
Fax Number : 714-451-0500
Provider Business Practice Location Address
First Line : 1001 E CHAPMAN AVE
Second Line : SUITE D
City : FULLERTON
State : CA
Zip : 92831-3811
Country : US
Telephone Number : 714-451-0000
Fax Number : 714-451-0500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 09/26/2011

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