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General NPI Number Information
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NPI Number | 1215633805
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Entity Type | Organization
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Legal Business Name | KODY SACKS-MOYNIHAN, M.D., INC.
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 4001 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-3626
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Country | US
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Telephone | 916-756-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 917 SAN SEBASTIAN ST
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City | DAVIS
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State | CA
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Zip | 95618-6515
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Country | US
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Telephone | 530-304-5639
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KODY SACKS-MOYNIHAN
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Credential | MD
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Telephone | 530-304-5639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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