Provider Demographics
NPI:1205009677
Name:MOY, MONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MONA
Other - Middle Name:YANG
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:506 ESTUDILLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4612
Mailing Address - Country:US
Mailing Address - Phone:510-483-1616
Mailing Address - Fax:510-483-3828
Practice Address - Street 1:506 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4612
Practice Address - Country:US
Practice Address - Phone:510-483-1616
Practice Address - Fax:510-483-3828
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist