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NPI Code Detail

MEDICARE: DR. LELAND JAY FOSHAG M.D.

MEDICARE: DR. LELAND JAY FOSHAG M.D.
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
12086X0206XSurgical Oncology PhysicianG61645CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2G61645OTHERCAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G61645OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1659441293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LELAND JAY FOSHAG M.D.
Provider Business Mailing Address
First Line : 2001 SANTA MONICA BLVD
Second Line : SUITE 560W
City : SANTA MONICA
State : CA
Zip : 90404-2102
Country : US
Telephone Number : 310-479-1215
Fax Number : 310-943-3144
Provider Business Practice Location Address
First Line : 11818 WILSHIRE BLVD
Second Line : SUITE 200
City : LOS ANGELES
State : CA
Zip : 90025-6646
Country : US
Telephone Number : 310-479-1215
Fax Number : 310-943-3144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 03/07/2023

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