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General NPI Number Information
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NPI Number | 1922310440
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Entity Type | Individual
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Provider Name | DR. SUNGJAE MOON
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Gender | Male
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 3727 W 6TH ST. SUIT 500
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City | LOS ANGELES
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State | CA
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Zip | 90020
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Country | US
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Telephone | 213-388-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 11806 HARTDALE AVE
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City | WHITTIER
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State | CA
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Zip | 90604-3239
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Country | US
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Telephone | 714-904-2676
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 12463
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License Number State | CA
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