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General NPI Number Information
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NPI Number | 1457576167
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Entity Type | Organization
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Legal Business Name | MOONFIELD MEDICAL MGMT. CORP
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 710 E PARKRIDGE AVE
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City | CORONA
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State | CA
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Zip | 92879-1097
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Country | US
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Telephone | 951-734-7600
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Fax | 951-734-1557
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Provider Business Mailing Address
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Address Line | PO BOX 1269
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City | CORONA
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State | CA
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Zip | 92878-1269
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Country | US
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Telephone | 951-734-7600
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Fax | 951-734-1557
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOON Y. LEE
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Credential | M.D.
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Telephone | 951-734-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A032377
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License Number State | CA
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