Active NPI
Keith Jay Wahl, MD
- Facial Plastic Surgery Physician
- La Jolla, CA
National Provider Identifier
1154743987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Facial Plastic Surgery Physician
- License
- A24790
- Practice address
- 8735 Nottingham PL
La Jolla, CA 92037-2129 - Phone
- (858) 518-2190
- Fax
- (858) 455-0655
- NPI assigned
- Jan 14, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Facial Plastic Surgery Physician | 207YS0123X | A24790 | CA | Primary |
Addresses
Primary practice location
8735 Nottingham PL
La Jolla, CA 92037-2129
Mailing address
8735 Nottingham PL
La Jolla, CA 92037-2129
Phone (858) 518-2190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A24790 | CA | MD | Facial Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556582400000",
"number": "1154743987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8735 NOTTINGHAM PL",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920372129",
"telephone_number": "858-518-2190",
"fax_number": "858-455-0655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8735 NOTTINGHAM PL",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920372129",
"telephone_number": "858-518-2190",
"fax_number": "858-455-0655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHL",
"first_name": "KEITH",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-14",
"last_updated": "2019-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "207YS0123X",
"taxonomy_group": "",
"desc": "Otolaryngology, Facial Plastic Surgery",
"state": "CA",
"license": "A24790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.