=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396740056
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL A GROSS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18364 CLARK ST
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-345-7122
-----------------------------------------------------
Fax | 818-345-7448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18364 CLARK ST
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-345-7122
-----------------------------------------------------
Fax | 818-345-7448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | A20584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207NS0135X
-----------------------------------------------------
Taxonomy Name | Procedural Dermatology Physician
-----------------------------------------------------
License Number | A20584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------