Healthcare Provider Details

I. General information

NPI: 1437410354
Provider Name (Legal Business Name): DANIEL JEONGHUN MOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEONGHUN MOON

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 440
RENTON WA
98055-5767
US

IV. Provider business mailing address

4033 TALBOT RD S STE 440
RENTON WA
98055-5767
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3494
  • Fax: 425-690-9494
Mailing address:
  • Phone: 425-690-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD60538616
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: