Healthcare Provider Details

I. General information

NPI: 1346037165
Provider Name (Legal Business Name): FILLERS.AI CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CRESTLINE DR APT 4
SAN FRANCISCO CA
94131-1422
US

IV. Provider business mailing address

2875 LAKEWOOD AVE SW # A5
ATLANTA GA
30315-5801
US

V. Phone/Fax

Practice location:
  • Phone: 832-894-0511
  • Fax: 862-227-4081
Mailing address:
  • Phone: 832-894-0511
  • Fax: 862-227-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUNG JOO MOON
Title or Position: CEO
Credential: MD
Phone: 713-904-0106