MEDICARE: DR. HONG BEOM MOON DDS, MS, FICD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	38095	CA

General Provider Information

NPI Number	:	1336420165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HONG BEOM MOON DDS, MS, FICD

Provider Business Mailing Address
First Line	:	3700 WILSHIRE BLVD STE 770
Second Line	:	SMILE WORLD ORTHODONTICS
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3008
Country	:	US
Telephone Number	:	213-365-2828
Fax Number	:	213-365-2822

Provider Business Practice Location Address
First Line	:	3700 WILSHIRE BLVD STE 770
Second Line	:	SMILE WORLD ORTHODONTICS
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3008
Country	:	US
Telephone Number	:	213-365-2828
Fax Number	:	213-365-2822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	05/04/2017

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