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General NPI Number Information
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NPI Number | 1245208453
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Entity Type | Organization
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Legal Business Name | MOON'S MULTI SPECIALTY CLINIC, SC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 1320 TOWER RD STE 144
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4309
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Country | US
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Telephone | 847-573-1157
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Fax | 224-513-5458
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Provider Business Mailing Address
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Address Line | 1320 TOWER RD STE 144
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4309
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Country | US
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Telephone | 847-573-1157
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Fax | 224-513-5458
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Authorized Official
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Title or Position | OWNER
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Name | JUNG H MOON
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Credential | DPM
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Telephone | 847-573-1157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-004899
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License Number State | IL
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