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General NPI Number Information
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NPI Number | 1336420165
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Entity Type | Individual
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Provider Name | HONG BEOM MOON DDS, MS, FICD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 3700 WILSHIRE BLVD STE 770 SMILE WORLD ORTHODONTICS
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City | LOS ANGELES
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State | CA
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Zip | 90010-3008
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Country | US
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Telephone | 213-365-2828
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Fax | 213-365-2822
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Provider Business Mailing Address
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Address Line | 3700 WILSHIRE BLVD STE 770 SMILE WORLD ORTHODONTICS
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City | LOS ANGELES
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State | CA
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Zip | 90010-3008
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Country | US
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Telephone | 213-365-2828
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Fax | 213-365-2822
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 38095
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License Number State | CA
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