Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | A106052 | CA |
N | 208200000X | Surgeon | A106052 | CA |
N | 208600000X | Surgeon | A106052 | CA |
NPI | 1699920652 |
---|---|
Provider Name | John Michael Moos |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 06/07/2015 |