Healthcare Provider Details

I. General information

NPI: 1750216628
Provider Name (Legal Business Name): DANIEL KIHO MOON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 W 130TH ST
HAWTHORNE CA
90250-5011
US

IV. Provider business mailing address

4906 W 130TH ST
HAWTHORNE CA
90250-5011
US

V. Phone/Fax

Practice location:
  • Phone: 310-874-1867
  • Fax:
Mailing address:
  • Phone: 310-874-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: