NPIMap

Organization Active NPI

Walt Jay Medical Corporation

Doing business as Integrative Industrial and Family Practice Medical Clinics

  • Pain Medicine (Anesthesiology) Physician
  • Los Angeles, CA
National Provider Identifier
1568501120
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
A23961 Issued in CA
Legal business name
WALT JAY MEDICAL CORPORATION
Doing business as
Integrative Industrial and Family Practice Medical Clinics
Practice address
1930 Wilshire Blvd
Suite 600
Los Angeles, CA 90057-3605
Phone
(213) 483-9902
Fax
(213) 483-5174
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Sherine Ganegoda
Title
Office Manager's Assistant
Phone
(213) 483-9902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X A23961 CA Primary

Addresses

Primary practice location

1930 Wilshire Blvd
Suite 600
Los Angeles, CA 90057-3605

Mailing address

318 N 3Rd St
Alhambra, CA 91801-2387
Phone (626) 943-7848

Other names 1

  • Integrative Industrial and Family Practice Medical Clinics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Integrative Industrial and Family Practice Medical Clinics6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568501120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 N 3RD ST",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918012387",
            "telephone_number": "626-943-7848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 WILSHIRE BLVD",
            "address_2": "SUITE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573605",
            "telephone_number": "213-483-9902",
            "fax_number": "213-483-5174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALT JAY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANEGODA",
        "authorized_official_first_name": "SHERINE",
        "authorized_official_title_or_position": "OFFICE MANAGER'S ASSISTANT",
        "authorized_official_telephone_number": "213-483-9902",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A23961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrative Industrial and Family Practice Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.