NPIMap

Organization Active NPI

Walt Jay Medical Corporation

  • Physical Medicine & Rehabilitation Physician
  • Los Angeles, CA
National Provider Identifier
1831238492
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
G00078400 Issued in CA
Legal business name
WALT JAY MEDICAL CORPORATION
Practice address
1930 Wilshire Blvd
Suite 505
Los Angeles, CA 90057-3605
Phone
(213) 483-9902
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
Sherine Ganegoda
Title
Office Manager'S Assistant
Phone
(213) 483-9902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X G00078400 CA Primary

Addresses

Primary practice location

1930 Wilshire Blvd
Suite 505
Los Angeles, CA 90057-3605

Mailing address

2011 Pray St
Fullerton, CA 92833-5070
Phone (661) 803-0468

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.

Locations

1930 Wilshire Blvd
Ste 505
Los Angeles, CA 90057
Phone (213) 483-9902

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1831238492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 PRAY ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928335070",
            "telephone_number": "661-803-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 WILSHIRE BLVD",
            "address_2": "SUITE 505",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573605",
            "telephone_number": "213-483-9902"
        }
    ],
    "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"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "G00078400",
            "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.