Healthcare Provider Details

I. General information

NPI: 1912374950
Provider Name (Legal Business Name): DR MATTHEW MO MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W VALLEY BLVD
ALHAMBRA CA
91803-1926
US

IV. Provider business mailing address

2140 W VALLEY BLVD
ALHAMBRA CA
91803-1926
US

V. Phone/Fax

Practice location:
  • Phone: 626-284-8881
  • Fax: 626-284-6805
Mailing address:
  • Phone: 626-284-8881
  • Fax: 626-284-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA37444
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA37444
License Number StateCA

VIII. Authorized Official

Name: MR. MATTHEW K MO
Title or Position: PRESIDENT
Credential: MD
Phone: 626-284-8881