Healthcare Provider Details

I. General information

NPI: 1447710017
Provider Name (Legal Business Name): EMILY SARAH MOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N MAIN ST
MILPITAS CA
95035-4322
US

IV. Provider business mailing address

143 N MAIN ST FAMILY MEDICINE
MILPITAS CA
95035
US

V. Phone/Fax

Practice location:
  • Phone: 408-957-8300
  • Fax:
Mailing address:
  • Phone: 408-957-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number161384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: