| Doctor Name: | DR. JAY WOHLGEMUTH |
| NPI Number: | 1043580921 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | A69610 |
| Business Practice Address: | 33608 Ortega Hwy San Juan Capistrano, CA - 926752042 |
| Business Phone Number: | 9497284271 |
| Business Fax Number: | |
| Mailing Address: | 33608 Ortega Hwy, SAN JUAN CAPISTRANO |
| State: | CA |
| Postal Code: | 926752042 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2012 |
| NPI Last Update Date: | 01/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A69610 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |