TINA LEE MOON PA-C
NPI 1104946383
Physician Assistant in San Dimas, CA
About Tina Lee Moon Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TINA LEE MOON PA-C (NPI 1104946383) is an individual physician assistant in San Dimas, California, licensed in California (15164) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS and is a graduate of Other (1999).
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Tina Lee Moon Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91773 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 13
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAN DIMAS, CA 91773
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tina Moon's NPI number?
The NPI number for Tina Moon is 1104946383. It was assigned to this individual provider in the NPPES registry on March 30, 2007. The provider is also known as Wauthena Lee Gary Pa-C.
Where is Tina Moon located?
Tina Moon practices at 1334 W Covina Blvd Suite 102, San Dimas, CA 91773. The listed phone number is (909) 599-8677.
What is Tina Moon's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Tina Moon enrolled in Medicare?
Yes. Tina Moon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Tina Moon was last updated on July 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 27 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Tina Lee Moon, PA-C · NPI 1104946383
Physician Assistant physician in San Dimas, California. Individual provider, active in the CMS NPPES registry since March 30, 2007.
## Identity
- **NPI:** 1104946383 (Entity type: Individual)
- **Enumerated:** March 30, 2007
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **State license:** 15164 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 1334 W COVINA BLVD, SUITE 102, San Dimas, CA 91773-3211
- **Phone:** (909) 599-8677 · **Fax:** (909) 592-0999
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 1999
## Record status
- **NPPES last updated:** July 21, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1104946383) · Data from the CMS NPPES public registry.