Basic Information
| Provider Information | |||||||||
| NPI: | 1942544515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LELAND J FOSHAG, MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15720 VENTURA BLVD STE 227 | ||||||||
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| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189077828 | ||||||||
| FaxNumber: | 8189076157 | ||||||||
| Practice Location | |||||||||
| Address1: | 11818 WILSHIRE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189077828 | ||||||||
| FaxNumber: | 8189076157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | FOSHAG | ||||||||
| AuthorizedOfficialFirstName: | LELAND | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8189077828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | G61645 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1659441293 | 01 | CA | NPI- INDIVIDUAL | OTHER |