Healthcare Provider Details

I. General information

NPI: 1821413295
Provider Name (Legal Business Name): MOSHE LEWIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 MAIN ST STE 200
REDWOOD CITY CA
94063-1759
US

IV. Provider business mailing address

2155 CHAMOMILE CT
SAN RAMON CA
94582-1304
US

V. Phone/Fax

Practice location:
  • Phone: 650-366-4542
  • Fax: 650-366-3896
Mailing address:
  • Phone: 650-366-4542
  • Fax: 650-366-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA90204
License Number StateCA

VIII. Authorized Official

Name: MOSHE LEWIS
Title or Position: MD
Credential:
Phone: 650-366-4542