Healthcare Provider Details

I. General information

NPI: 1871402206
Provider Name (Legal Business Name): DWANA ALANA MOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S GRADY WAY STE 610
RENTON WA
98057-3218
US

IV. Provider business mailing address

14200 SE 272ND ST APT F102
KENT WA
98042-8044
US

V. Phone/Fax

Practice location:
  • Phone: 206-679-8291
  • Fax: 206-274-6252
Mailing address:
  • Phone: 206-679-8291
  • Fax: 206-274-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: