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General NPI Number Information
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NPI Number | 1053087312
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Entity Type | Organization
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Legal Business Name | LOUIS MOON DDS, INC.
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 14130 CULVER DR STE C
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City | IRVINE
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State | CA
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Zip | 92604-0321
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Country | US
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Telephone | 949-653-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BARRINGTON
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City | IRVINE
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State | CA
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Zip | 92618-0841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOUIS MOON
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Credential | DDS
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Telephone | 714-292-1576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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