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NPI Code Detail

MEDICARE: DR. KYLE ANTHONY MOORE M.D.

MEDICARE: DR. KYLE ANTHONY MOORE 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
1207RA0401XAddiction Medicine (Internal Medicine) PhysicianCA 043351CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568580322
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE ANTHONY MOORE M.D.
Provider Business Mailing Address
First Line : PO BOX 70072
Second Line :
City : RICHMOND
State : CA
Zip : 94807-0072
Country : US
Telephone Number : 510-375-0891
Fax Number : 510-232-8652
Provider Business Practice Location Address
First Line : 1313 CUTTING BLVD
Second Line :
City : RICHMOND
State : CA
Zip : 94804-2554
Country : US
Telephone Number : 510-232-0874
Fax Number : 510-232-8652
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 09/06/2023

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