Healthcare Provider Details

I. General information

NPI: 1366420952
Provider Name (Legal Business Name): MOON K YOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOON K YOON MD

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 PARRISH RD
CONNEAUT OH
44030-2013
US

IV. Provider business mailing address

224 PARRISH RD
CONNEAUT OH
44030-2013
US

V. Phone/Fax

Practice location:
  • Phone: 440-599-1024
  • Fax: 440-599-9590
Mailing address:
  • Phone: 440-599-1024
  • Fax: 440-599-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35100275Y
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: