Provider Demographics
NPI:1043443716
Name:MOY, NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MOY
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:PO BOX 741515
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-1515
Mailing Address - Country:US
Mailing Address - Phone:425-637-1855
Mailing Address - Fax:206-344-7970
Practice Address - Street 1:11695 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5268
Practice Address - Country:US
Practice Address - Phone:425-637-1855
Practice Address - Fax:206-344-7970
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102963207R00000X
WAMD60286403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043443716Medicaid
WAP01121109OtherRAILROAD MEDICARE
WA0299108OtherLABOR & INDUSTRY
WA1043443716Medicaid
WA8914806Medicare PIN