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General NPI Number Information
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NPI Number | 1730411703
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Entity Type | Organization
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Legal Business Name | HYE WON MOON D.D.S. INC.
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 4026 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-3257
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Country | US
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Telephone | 323-732-2828
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Fax | 323-732-9737
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Provider Business Mailing Address
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Address Line | 4026 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-2351
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Country | US
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Telephone | 323-732-2828
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Fax | 323-732-9737
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. HYE WON MOON
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Credential | DDS
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Telephone | 323-732-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 45925
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License Number State | CA
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