Provider Demographics
NPI:1912374950
Name:DR MATTHEW MO MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR MATTHEW MO MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:K
Authorized Official - Last Name:MO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-284-8881
Mailing Address - Street 1:2140 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1926
Mailing Address - Country:US
Mailing Address - Phone:626-284-8881
Mailing Address - Fax:626-284-6805
Practice Address - Street 1:2140 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1926
Practice Address - Country:US
Practice Address - Phone:626-284-8881
Practice Address - Fax:626-284-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37444207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty