Healthcare Provider Details

I. General information

NPI: 1518653104
Provider Name (Legal Business Name): MR. DANIEL TED MOY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A7
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

16521 S FIGUEROA ST APT 133
GARDENA CA
90248-2674
US

V. Phone/Fax

Practice location:
  • Phone: 301-602-6567
  • Fax:
Mailing address:
  • Phone: 301-602-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: