Provider Demographics
NPI:1073145827
Name:MOC, KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MOC
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BRENTON CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4908
Mailing Address - Country:US
Mailing Address - Phone:626-551-8037
Mailing Address - Fax:
Practice Address - Street 1:838 W DANA ST STE A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1219
Practice Address - Country:US
Practice Address - Phone:626-551-8037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor