MEDICARE: 888 MEDICAL CLINIC & SPA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A16238	OTHER	CA	CALIFORNIA OSTEOPATHIC LICENSE

General Provider Information

NPI Number	:	1427834027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	888 MEDICAL CLINIC & SPA

Provider Business Mailing Address
First Line	:	16661 VENTURA BLVD STE 703
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4815
Country	:	US
Telephone Number	:	310-844-6751
Fax Number	:

Provider Business Practice Location Address
First Line	:	16661 VENTURA BLVD STE 703
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4815
Country	:	US
Telephone Number	:	310-844-6751
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LELAND DAO
Credential	:	D.O.
Telephone Number	:	310-844-6751

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/27/2023

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