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General NPI Number Information
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NPI Number | 1083078315
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Entity Type | Individual
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Provider Name | JUNG JOO MOON M.D., M.M.S
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Gender | Female
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 2875 LAKEWOOD AVE SW # A5
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City | ATLANTA
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State | GA
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Zip | 30315-5801
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Country | US
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Telephone | 713-904-0106
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Fax | 862-227-4081
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Provider Business Mailing Address
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Address Line | 2875 LAKEWOOD AVE SW STE 1138
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City | ATLANTA
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State | GA
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Zip | 30315-5801
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Country | US
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Telephone | 713-904-0106
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Fax | 862-227-4081
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 70750
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 76451
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 646517
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 90144
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License Number State | GA
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