Healthcare Provider Details

I. General information

NPI: 1043443716
Provider Name (Legal Business Name): NICHOLAS MOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11695 NE 4TH ST
BELLEVUE WA
98004-5268
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 425-637-1855
  • Fax: 206-344-7970
Mailing address:
  • Phone: 425-637-1855
  • Fax: 206-344-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60286403
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: