Healthcare Provider Details

I. General information

NPI: 1598180689
Provider Name (Legal Business Name): DAI OK MOON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NORTH CLAYTON STREET ST FRANCIS HOSPITAL
WIMINGTON DE
19805
US

IV. Provider business mailing address

C-83 OMEGA DRIVE
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-0600
  • Fax: 302-731-0605
Mailing address:
  • Phone: 302-731-0600
  • Fax: 302-731-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberC1-0002324
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC10002324
License Number StateDE

VIII. Authorized Official

Name: DAI O MOON
Title or Position: OWNER
Credential: MD, PA
Phone: 302-731-0600