Provider Demographics
NPI:1659349785
Name:MOORE, KAYA (PAC)
Entity Type:Individual
Prefix:
First Name:KAYA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-617-8100
Mailing Address - Fax:650-327-2947
Practice Address - Street 1:1950 UNIVERSITY AVE
Practice Address - Street 2:160
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2250
Practice Address - Country:US
Practice Address - Phone:650-617-8100
Practice Address - Fax:650-327-2947
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18798363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ44447Medicare UPIN