Provider Demographics
NPI:1922043272
Name:TIN, MOE T (MD)
Entity Type:Individual
Prefix:
First Name:MOE
Middle Name:T
Last Name:TIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10690
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0690
Mailing Address - Country:US
Mailing Address - Phone:562-809-3554
Mailing Address - Fax:
Practice Address - Street 1:17772 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6819
Practice Address - Country:US
Practice Address - Phone:714-842-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81818207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A818180Medicaid
G93137Medicare UPIN
CAHA81818Medicare ID - Type Unspecified