MEDICARE: GOOD NEIGHBOR CLINIC FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	101YP2500X	Professional Counselor
4	1041C0700X	Clinical Social Worker
5	133N00000X	Nutritionist
6	156F00000X	Technician/Technologist
7	163WC0400X	Case Management Registered Nurse
8	171400000X	Health & Wellness Coach
9	174200000X	Meals Provider
10	2084P0800X	Psychiatry Physician
11	213EP1101X	Primary Podiatric Medicine Podiatrist
12	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1043162076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD NEIGHBOR CLINIC FOUNDATION

Provider Business Mailing Address
First Line	:	4300 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4902
Country	:	US
Telephone Number	:	323-298-1668
Fax Number	:	323-298-0458

Provider Business Practice Location Address
First Line	:	4300 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4902
Country	:	US
Telephone Number	:	323-298-1668
Fax Number	:	323-298-0458

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. DANIEL DAVIDSON
Credential	:	MD
Telephone Number	:	310-212-1500

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “GOOD NEIGHBOR CLINIC FOUNDATION ” Practice Location

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