Provider Demographics
NPI:1659441293
Name:FOSHAG, LELAND JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:JAY
Last Name:FOSHAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 560W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-479-1215
Mailing Address - Fax:310-943-3144
Practice Address - Street 1:11818 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6646
Practice Address - Country:US
Practice Address - Phone:310-479-1215
Practice Address - Fax:310-943-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG616452086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61645OtherMEDICAL LICENSE
CAG61645OtherMEDICARE PTAN
CAG61645OtherMEDICARE PTAN
CAG61645OtherMEDICAL LICENSE
CAC35170Medicare UPIN