Healthcare Provider Details

I. General information

NPI: 1174756357
Provider Name (Legal Business Name): MOON M OH M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BARRANCA PKWY 330
IRVINE CA
92606-8226
US

IV. Provider business mailing address

3500 BARRANCA PKWY STE 330
IRVINE CA
92606-8288
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-8217
  • Fax: 949-809-9514
Mailing address:
  • Phone: 949-552-8217
  • Fax: 949-809-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA107209
License Number StateCA

VIII. Authorized Official

Name: MOON M OH
Title or Position: OWNER
Credential: MD
Phone: 949-552-8216