# WALT JAY MEDICAL CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Integrative Industrial and Family Practice Medical Clinics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124164579
- **Authorized official:** MRS. SHERINE GANEGODA (OFFICE MANAGER'S ASSISTANT)
- **Authorized official phone:** (213) 483-9902

## Contact information

- **Practice address:** 1930 WILSHIRE BLVD, SUITE 600, LOS ANGELES, CA 90057-3605
- **Practice address phone:** (213) 483-9902
- **Practice address fax:** (213) 483-5174
- **Mailing address:** 1010 SUMMITRIDGE DR, DIAMOND BAR, CA 91765-4364
- **Mailing address phone:** (909) 860-9528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A366519 | CA | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 08/22/2020