Tina Lee Moon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15164 Issued in CA

Practice address

1334 W Covina Blvd
Suite 102
San Dimas, CA 91773-3211

Phone

(909) 599-8677

Fax

(909) 592-0999

NPI assigned

Mar 30, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Wauthena Lee Gary Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group
• California Wound Healing Medical Group Inc.

  • Surgical Physician Assistant
  • Alhambra, CA
  • NPI 1235333972
  Medicare reassignment
• Skilled Facility Health Care Solutions Inc

  • Surgery Physician
  • Los Angeles, CA
  • NPI 1104018423
  Medicare reassignment
• Skilled Facility Health Care Solutions Inc

  • Surgery Physician
  • Los Angeles, CA
  • NPI 1306001805
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fontana, CA
  • NPI 1689606196
  NPD
• New Hope Podiatry Group Inc.

  • Foot & Ankle Surgery Podiatrist
  • Alhambra, CA
  • NPI 1447670955
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1104946383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7809 HEMLOCK AVE",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923454119",
            "telephone_number": "951-830-0496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 W COVINA BLVD",
            "address_2": "SUITE 102",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733211",
            "telephone_number": "909-599-8677",
            "fax_number": "909-592-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "TINA",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "15164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1334 W Covina Blvd",
            "address_2": "SUITE 102",
            "city": "San Dimas",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917733211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "WAUTHENA",
            "last_name": "GARY",
            "middle_name": "LEE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maria Isabel Molina, RD
• Martin G Monarrez, MASLP
• Rocio Naraved Montes
• Carol S Montgomery, MFT
• Heidi Sofia Montiel Rosales
• Autumn Rae Moore
• Kameron Brajon Moore
• Tracy Moore
• Jonathan Morales
• Victor Morales, MD

• Physician Assistant in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.