MEDICARE: HEALING GARDEN MEDICAL CLINIC

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	207Y00000X	Otolaryngology Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1730037003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING GARDEN MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	210 S KENWOOD ST STE 100
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-5109
Country	:	US
Telephone Number	:	747-777-2808
Fax Number	:	747-777-2809

Provider Business Practice Location Address
First Line	:	210 S KENWOOD ST STE 100
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-5109
Country	:	US
Telephone Number	:	747-777-2808
Fax Number	:	747-777-2809

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	GARY FORD
Credential	:	MD
Telephone Number	:	747-777-2808

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	05/28/2026

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