Basic Information
| Provider Information | |||||||||
| NPI: | 1629260948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUKAI | ||||||||
| FirstName: | MOSES | ||||||||
| MiddleName: | TAKESHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19333 BEAR VALLEY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923085148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602405505 | ||||||||
| FaxNumber: | 7602455525 | ||||||||
| Practice Location | |||||||||
| Address1: | 19333 BEAR VALLEY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923085148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602405505 | ||||||||
| FaxNumber: | 7602455525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 20A-5527 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.