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General NPI Number Information
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NPI Number | 1558776088
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Entity Type | Individual
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Provider Name | HWI MOON DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 601 S CARR RD STE 300
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City | RENTON
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State | WA
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Zip | 98055-5840
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Country | US
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Telephone | 425-277-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S CARR RD STE 300
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City | RENTON
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State | WA
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Zip | 98055-5840
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Country | US
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Telephone | 425-277-1844
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS040106
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DE61286690
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | S9191
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 34932
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DS040106
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | MD61279945
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License Number State | WA
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