Healthcare Provider Details

I. General information

NPI: 1871851717
Provider Name (Legal Business Name): ENG W MOY M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 05/30/2012
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 Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA37125
License Number StateCA

VIII. Authorized Official

Name: ENG W MOY
Title or Position: PRESIDENT
Credential: MD
Phone: 323-566-5129