Healthcare Provider Details

I. General information

NPI: 1710807847
Provider Name (Legal Business Name): JI MIN MOON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 CAMINO REAL
JURUPA VALLEY CA
92509-5310
US

IV. Provider business mailing address

6000 CAMINO REAL
JURUPA VALLEY CA
92509-5310
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JI MIN MOON
Title or Position: PRESIDENT
Credential: DDS
Phone: 951-215-5918