| Doctor Name: | CHANG WON MOON |
| NPI Number: | 1053479964 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 193368 |
| Business Practice Address: | B Co 168 Med Bn Apo, AP - 96205 |
| Business Phone Number: | 3157416650 |
| Business Fax Number: | |
| Mailing Address: | B Co 168 Med Bn, APO |
| State: | AP |
| Postal Code: | 96205 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 193368 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |