Provider Demographics
NPI:1255384525
Name:MOY, ENG WEI (MD)
Entity type:Individual
Prefix:
First Name:ENG
Middle Name:WEI
Last Name:MOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6219
Mailing Address - Country:US
Mailing Address - Phone:323-566-5129
Mailing Address - Fax:323-566-2013
Practice Address - Street 1:4301 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6219
Practice Address - Country:US
Practice Address - Phone:323-566-5129
Practice Address - Fax:323-566-2013
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA37125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8109916Medicaid
CA8109916Medicaid
CAA28307Medicare UPIN