Healthcare Provider Details

I. General information

NPI: 1306758552
Provider Name (Legal Business Name): YOUN JIN MOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 MAIN ST STE 222
DULUTH GA
30096-3262
US

IV. Provider business mailing address

3715 MCCLURE WOODS DR
DULUTH GA
30096-8510
US

V. Phone/Fax

Practice location:
  • Phone: 678-887-7484
  • Fax:
Mailing address:
  • Phone: 678-887-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number575
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: