Provider Demographics
NPI:1235219312
Name:MOAS, OVI (MD)
Entity Type:Individual
Prefix:
First Name:OVI
Middle Name:
Last Name:MOAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2209
Mailing Address - Country:US
Mailing Address - Phone:626-285-7158
Mailing Address - Fax:626-285-9392
Practice Address - Street 1:9815 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2209
Practice Address - Country:US
Practice Address - Phone:626-285-7158
Practice Address - Fax:626-285-9392
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357300Medicaid
CA00A357300Medicaid
A27887Medicare UPIN