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General NPI Number Information
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NPI Number | 1033441902
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Entity Type | Individual
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Provider Name | SAM LYEON MOON L.AC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 1288 KIFER RD #202
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City | SUNNYVALE
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State | CA
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Zip | 94086-5327
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Country | US
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Telephone | 408-720-1766
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 UNIVERSITY DR #202B
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City | MENLO PARK
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State | CA
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Zip | 94025-4262
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Country | US
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Telephone | 408-930-7706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 13171
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License Number State | CA
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