Healthcare Provider Details

I. General information

NPI: 1073571899
Provider Name (Legal Business Name): KAI H MOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 N 3RD ST
HARRISBURG PA
17110-2001
US

IV. Provider business mailing address

800 HERITAGE DR STE 810
POTTSTOWN PA
19464-9220
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-4650
  • Fax: 717-782-4665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD043806E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: