=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497839708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAX MOSES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 11/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 COUNTRY DR SUITE 100
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-5329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-862-9961
-----------------------------------------------------
Fax | 877-871-1371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5424 SUNOL BLVD SUITE 10-262
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-7705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-862-9961
-----------------------------------------------------
Fax | 877-871-1371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A29314
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------