WALT JAY MEDICAL CORPORATION NPI 1124164579

NPI Information

  • NPI: 1124164579
  • Provider Name: WALT JAY MEDICAL CORPORATION
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Doing Business As: INTEGRATIVE INDUSTRIAL AND FAMILY PRACTICE MEDICAL CLINICS
  • Address: 1930 WILSHIRE BLVD
    SUITE 600
    LOS ANGELES, CA
    ZIP 90057
  • Phone: (213) 483-9902

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NPI Details

WALT JAY MEDICAL CORPORATION is a general practice in Los Angeles, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee WALT JAY MEDICAL CORPORATION NPI is 1124164579. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Integrative Industrial And Family Practice Medical Clinics.

The provider's business location address is:

1930 WILSHIRE BLVD
SUITE 600
LOS ANGELES, CA
ZIP 90057-605
Phone: (213) 483-9902
Fax: (213) 483-5174

The provider's authorized official is Sherine Ganegoda .
The authorized official title is Office Manager's Assistant and has the following contact phone number (213) 483-9902.

The enumeration date for this NPI number is 1/30/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeA366519CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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