Provider Demographics
NPI:1689760316
Name:CARL K. MOY, M.D. INC.
Entity Type:Organization
Organization Name:CARL K. MOY, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-626-5151
Mailing Address - Street 1:711 W COLLEGE ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1163
Mailing Address - Country:US
Mailing Address - Phone:213-626-5151
Mailing Address - Fax:213-626-0510
Practice Address - Street 1:711 W COLLEGE ST
Practice Address - Street 2:SUITE 540
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1163
Practice Address - Country:US
Practice Address - Phone:213-626-5151
Practice Address - Fax:213-626-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063871Medicaid