Healthcare Provider Details

I. General information

NPI: 1255384525
Provider Name (Legal Business Name): ENG WEI MOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 TWEEDY BLVD
SOUTH GATE CA
90280-6219
US

IV. Provider business mailing address

4301 TWEEDY BLVD
SOUTH GATE CA
90280-6219
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-5129
  • Fax: 323-566-2013
Mailing address:
  • Phone: 323-566-5129
  • Fax: 323-566-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA37125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: