MEDICARE: LAWRENCE S. MOY MD INC

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	207NS0135X	Procedural Dermatology Physician	G62367	CA

General Provider Information

NPI Number	:	1225226160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE S. MOY MD INC

Provider Business Mailing Address
First Line	:	1101 N SEPULVEDA BLVD STE 100
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5962
Country	:	US
Telephone Number	:	310-546-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N SEPULVEDA BLVD STE 100
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5962
Country	:	US
Telephone Number	:	310-546-7780
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LAWRENCE S MOY
Credential	:	MD
Telephone Number	:	310-546-7780

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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