Healthcare Provider Details

I. General information

NPI: 1104321421
Provider Name (Legal Business Name): MR. LEONARD TIGER ONSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER STE 400
LOS ANGELES CA
90045-9212
US

IV. Provider business mailing address

370 W OAK ST
COAL CITY IL
60416-1466
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7200
  • Fax:
Mailing address:
  • Phone: 815-325-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036171278
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA185557
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036171278
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: