Healthcare Provider Details

I. General information

NPI: 1942544515
Provider Name (Legal Business Name): LELAND J FOSHAG, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 WILSHIRE BLVD STE 200
LOS ANGELES CA
90025-6647
US

IV. Provider business mailing address

15720 VENTURA BLVD STE 227
ENCINO CA
91436-2978
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-7828
  • Fax: 818-907-6157
Mailing address:
  • Phone: 818-907-7828
  • Fax: 818-907-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG61645
License Number StateCA

VIII. Authorized Official

Name: DR. LELAND JAY FOSHAG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-907-7828