Healthcare Provider Details

I. General information

NPI: 1003004946
Provider Name (Legal Business Name): EDDIE JOOHYUN MOON DAOM, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOO HYUN MOON DAOM, L.AC.

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 E COLORADO BLVD STE.201
PASADENA CA
91101-2127
US

IV. Provider business mailing address

758 E COLORADO BLVD STE.201
PASADENA CA
91101-2127
US

V. Phone/Fax

Practice location:
  • Phone: 213-268-3007
  • Fax:
Mailing address:
  • Phone: 213-268-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: