Provider Demographics
NPI:1306919899
Name:MO, MATTHEW KAM YU (MD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KAM YU
Last Name:MO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2140 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803
Mailing Address - Country:US
Mailing Address - Phone:626-284-8881
Mailing Address - Fax:626-284-6805
Practice Address - Street 1:2140 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803
Practice Address - Country:US
Practice Address - Phone:626-284-8881
Practice Address - Fax:626-284-6805
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA374444207Q00000X
CAA37444208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A374440Medicaid
CA00A374440Medicaid
CAA85013Medicare UPIN