Provider Demographics
NPI:1629260948
Name:MUKAI, MOSES TAKESHI JR (DO)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:TAKESHI
Last Name:MUKAI
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:19333 BEAR VALLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-5148
Mailing Address - Country:US
Mailing Address - Phone:760-240-5505
Mailing Address - Fax:760-245-5525
Practice Address - Street 1:19333 BEAR VALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5148
Practice Address - Country:US
Practice Address - Phone:760-240-5505
Practice Address - Fax:760-245-5525
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2021-11-08
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Provider Licenses
StateLicense IDTaxonomies
CA20A-5527207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR197YMedicare PIN