Healthcare Provider Details

I. General information

NPI: 1881742856
Provider Name (Legal Business Name): MARJORIE C. HSU-MOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W 3RD ST
LONG BEACH CA
90802-2745
US

IV. Provider business mailing address

730 W 3RD ST
LONG BEACH CA
90802-2745
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-5040
  • Fax:
Mailing address:
  • Phone: 562-435-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: