Healthcare Provider Details

I. General information

NPI: 1447468236
Provider Name (Legal Business Name): JASON FREDERICK MOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6330
  • Fax: 925-932-0139
Mailing address:
  • Phone: 925-932-6330
  • Fax: 925-932-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301077667
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number244628
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA104905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: