Healthcare Provider Details

I. General information

NPI: 1821259102
Provider Name (Legal Business Name): CHRISTINA SOYOUNG MOON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTE BLVD 3 WEST PAVILION
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTE BLVD 3 WEST PAVILION
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-614-4100
  • Fax: 215-615-0527
Mailing address:
  • Phone: 215-614-4100
  • Fax: 215-615-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD443252
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: