MEDICARE: DR. JAMES K. MOONEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G14377	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073517603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES K. MOONEY M.D.

Provider Business Mailing Address
First Line	:	3300 WEBSTER ST
Second Line	:	STE 710
City	:	OAKLAND
State	:	CA
Zip	:	94609-3122
Country	:	US
Telephone Number	:	510-465-5800
Fax Number	:	510-839-8984

Provider Business Practice Location Address
First Line	:	3300 WEBSTER ST
Second Line	:	STE 710
City	:	OAKLAND
State	:	CA
Zip	:	94609-3117
Country	:	US
Telephone Number	:	510-465-5800
Fax Number	:	510-839-8984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/02/2008

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