Healthcare Provider Details

I. General information

NPI: 1144029570
Provider Name (Legal Business Name): KATHERINE SOYOUNG MOON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 HILL BLVD STE K
YORKTOWN HEIGHTS NY
10598-1210
US

IV. Provider business mailing address

3505 HILL BLVD
YORKTOWN HEIGHTS NY
10598-1283
US

V. Phone/Fax

Practice location:
  • Phone: 914-352-6116
  • Fax:
Mailing address:
  • Phone: 914-352-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: