MEDICARE: DR. MOSES TAKESHI MUKAI JR. D.O.

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	207V00000X	Obstetrics & Gynecology Physician	20A-5527	CA

General Provider Information

NPI Number	:	1629260948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOSES TAKESHI MUKAI JR. D.O.

Provider Business Mailing Address
First Line	:	19333 BEAR VALLEY RD
Second Line	:	SUITE 106
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5148
Country	:	US
Telephone Number	:	760-240-5505
Fax Number	:	760-245-5525

Provider Business Practice Location Address
First Line	:	19333 BEAR VALLEY RD
Second Line	:	SUITE 106
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5148
Country	:	US
Telephone Number	:	760-240-5505
Fax Number	:	760-245-5525

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	11/08/2021

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