Provider Demographics
NPI:1376115428
Name:BEN MOSHE, YISHAY (MD)
Entity type:Individual
Prefix:DR
First Name:YISHAY
Middle Name:
Last Name:BEN MOSHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 FANNIN STREET
Mailing Address - Street 2:SUITE 1560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-822-4292
Mailing Address - Fax:832-825-4294
Practice Address - Street 1:6701 FANNIN STREET
Practice Address - Street 2:SUITE 1560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-822-4292
Practice Address - Fax:832-825-4294
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2024-09-24
Deactivation Date:2022-12-19
Deactivation Code:
Reactivation Date:2022-12-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX48420207SG0201X, 207SG0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0207XAllopathic & Osteopathic PhysiciansMedical GeneticsMedical Biochemical Genetics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)