NPIMap

Organization Active NPI

Janesri de Silva, MD a Prof Corp

  • Pediatrics Physician
  • Van Nuys, CA
National Provider Identifier
1114253671
Registry record updated Oct 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A88991 Issued in CA
Legal business name
JANESRI DE SILVA, MD A PROF CORP
Doing business as
KIDS & TEENS MEDICAL GROUP
Practice address
15211 Vanowen St
Suite 102
Van Nuys, CA 91405-3606
Phone
(818) 782-7600
Fax
(818) 782-9077
NPI assigned
Oct 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Janesri Wijayangani De Silva, M.D.
Title
President
Phone
(818) 782-7600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X A88991 CA Primary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X A88991 CA

Addresses

Primary practice location

15211 Vanowen St
Suite 102
Van Nuys, CA 91405-3606

Mailing address

18543 Devonshire St
Suite 430
Northridge, CA 91324-1308
Phone (818) 782-7600

Other identifiers 1

IdentifierTypeStateIssuer
00A889910MedicaidCA

Other names 1

  • KIDS & TEENS MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Janesri de Silva MD a Prof Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

18543 Devonshire St
Northridge, CA 91324
Phone (818) 267-0019

15211 Vanowen St
Ste 102
Van Nuys, CA 91405
Phone (818) 782-7600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255910400000",
    "number": "1114253671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18543 DEVONSHIRE ST",
            "address_2": "SUITE 430",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913241308",
            "telephone_number": "818-782-7600",
            "fax_number": "818-782-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15211 VANOWEN ST",
            "address_2": "SUITE 102",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053606",
            "telephone_number": "818-782-7600",
            "fax_number": "818-782-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANESRI DE SILVA, MD A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-19",
        "last_updated": "2009-10-19",
        "status": "A",
        "authorized_official_last_name": "DE SILVA",
        "authorized_official_first_name": "JANESRI",
        "authorized_official_middle_name": "WIJAYANGANI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-782-7600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A88991",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A88991",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A889910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIDS & TEENS MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.