Healthcare Provider Details

I. General information

NPI: 1407768658
Provider Name (Legal Business Name): JASON MOY, MD, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 SHADELANDS DR STE B
WALNUT CREEK CA
94598-2512
US

IV. Provider business mailing address

24 NORTHRIDGE LN
LAFAYETTE CA
94549-3146
US

V. Phone/Fax

Practice location:
  • Phone: 925-788-1577
  • Fax:
Mailing address:
  • Phone: 925-788-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON FREDERICK MOY
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 925-788-1577