Healthcare Provider Details

I. General information

NPI: 1366415309
Provider Name (Legal Business Name): SCOTT D.M. MOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST THE QUEEN'S MEDICAL CENTER DEPT OF RAD ONC
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

1301 PUNCHBOWL ST THE QUEEN'S MEDICAL CENTER DEPT OF RAD ONC
HONOLULU HI
96813-2402
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-4771
  • Fax: 808-691-4507
Mailing address:
  • Phone: 808-691-4771
  • Fax: 808-691-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD93402
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number7901
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: