Active NPI
Jason Moore
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Los Angeles, CA
National Provider Identifier
1679400899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 51739
- Practice address
- 4061 Karelia St
Los Angeles, CA 90065-3307 - Phone
- (323) 309-9919
- NPI assigned
- May 4, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 51739 | CA | Primary |
Addresses
Primary practice location
4061 Karelia St
Los Angeles, CA 90065-3307
Mailing address
1577 E Chevy Chase Dr Ste 110
Glendale, CA 91206-4091
Phone (323) 309-9919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51739 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1679400899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1577 E CHEVY CHASE DR STE 110",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912064091",
"telephone_number": "323-309-9919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4061 KARELIA ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900653307",
"telephone_number": "323-309-9919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-05-04",
"last_updated": "2026-05-20",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "CA",
"license": "51739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.