Healthcare Provider Details

I. General information

NPI: 1215825013
Provider Name (Legal Business Name): JINHWA MOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALIFORNIA STATE UNIVERSITY, BAKERSFIELD DEPARTMENT OF NURSING, 9001 STOCKDALE HWY.
BAKERSFIELD CA
93311
US

IV. Provider business mailing address

CALIFORNIA STATE UNIVERSITY, BAKERSFIELD DEPARTMENT OF NURSING, 9001 STOCKDALE HWY.
BAKERSFIELD CA
93311
US

V. Phone/Fax

Practice location:
  • Phone: 661-654-2505
  • Fax: 999-999-9999
Mailing address:
  • Phone: 661-654-2505
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN95258127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: