Provider Demographics
NPI:1821064007
Name:MOY, TOM Y (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:Y
Last Name:MOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1500
Mailing Address - Fax:909-398-1573
Practice Address - Street 1:1866 N ORANGE GROVE AVE
Practice Address - Street 2:#202
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3031
Practice Address - Country:US
Practice Address - Phone:909-623-8796
Practice Address - Fax:909-623-3076
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35574207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A355740Medicaid
CA00A355740Medicaid
CAA35574Medicare PIN
CAA27839Medicare UPIN