Provider Demographics
NPI:1629206768
Name:MOY, JING FON (DO)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:FON
Last Name:MOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742244
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2244
Mailing Address - Country:US
Mailing Address - Phone:408-340-5700
Mailing Address - Fax:510-974-8322
Practice Address - Street 1:15425 LOS GATOS BLVD
Practice Address - Street 2:STE 120
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2541
Practice Address - Country:US
Practice Address - Phone:408-340-5700
Practice Address - Fax:510-974-8322
Is Sole Proprietor?:No
Enumeration Date:2009-06-27
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HA329ZOtherMEDICARE PTAN