Provider Demographics
NPI:1265593651
Name:MOYER, KATHRYN L (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:L
Last Name:MOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9911 W PICO BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2703
Mailing Address - Country:US
Mailing Address - Phone:310-203-8899
Mailing Address - Fax:310-203-8555
Practice Address - Street 1:9911 W PICO BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2703
Practice Address - Country:US
Practice Address - Phone:310-203-8899
Practice Address - Fax:310-203-8555
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45069207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG45069CMedicare ID - Type Unspecified
CAA92546Medicare UPIN
CAWG45069DMedicare ID - Type Unspecified
CAWG45069AMedicare ID - Type Unspecified
CAWG45069BMedicare ID - Type Unspecified
CAWG45069EMedicare ID - Type Unspecified