Healthcare Provider Details

I. General information

NPI: 1972243392
Provider Name (Legal Business Name): JADE YUNKYUNG MOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 14TH ST STE 219S
NEW YORK NY
10003-4284
US

IV. Provider business mailing address

310 E 14TH ST STE 219S
NEW YORK NY
10003-4284
US

V. Phone/Fax

Practice location:
  • Phone: 646-605-8119
  • Fax:
Mailing address:
  • Phone: 646-605-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number342941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: