Healthcare Provider Details

I. General information

NPI: 1972763621
Provider Name (Legal Business Name): DAVID MOON IL LIM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

13026 CREEK PARK DR
POWAY CA
92064-5764
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A14703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: