Provider Demographics
NPI:1801908322
Name:MOE, JIMMY (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:MOE
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 1:515 LA CASA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-5028
Mailing Address - Country:US
Mailing Address - Phone:646-410-1187
Mailing Address - Fax:844-868-1254
Practice Address - Street 1:515 LA CASA AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-5028
Practice Address - Country:US
Practice Address - Phone:646-410-1187
Practice Address - Fax:844-868-1254
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242730-1207L00000X
CAA96307207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH306ZMedicare PIN