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General NPI Number Information
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NPI Number | 1043203334
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Entity Type | Individual
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Provider Name | RONALD TAI YOUNG MOON D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 820 UNIVERSITY BLVD
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1111
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Country | US
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Telephone | 205-327-5030
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Fax | 205-327-5616
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Provider Business Mailing Address
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Address Line | 820 UNIVERSITY BLVD
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1111
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Country | US
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Telephone | 205-327-5030
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Fax | 205-327-5616
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | DO-419
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License Number State | AL
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