Organization Name: | YOUNGSIK MOON, M.D., P.A. |
NPI Number: | 1245447465 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BETTY ANN QUADE (BUSINESS MANAGER) |
Mailing Address: | 24435 Mervell Dean Rd Hollywood |
State: | MD US |
Postal Code: | 206362712 |
Phone Number: | 3013732116 |
Fax Number: | 3013735281 |
NPI Enumeration Date: | 05/17/2007 |
NPI Last Update Date: | 03/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D09178 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |