MEDICARE: MODEN MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
3	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
4	2083B0002X	Obesity Medicine (Preventive Medicine) Physician
5	2084N0400X	Neurology Physician
6	2084P0800X	Psychiatry Physician
7	208D00000X	General Practice Physician
8	208M00000X	Hospitalist Physician
9	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1003422643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODEN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	237 A ST # 93791
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4003
Country	:	US
Telephone Number	:	888-822-1184
Fax Number	:	888-877-3676

Provider Business Practice Location Address
First Line	:	8901 ACTIVITY RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4436
Country	:	US
Telephone Number	:	888-822-1184
Fax Number	:	888-877-3676

Authorized Official
Title or Position	:	CEO
Name	:	HOJUNG JOSEPH YOON
Credential	:	MD
Telephone Number	:	888-822-1184

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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Directions to “MODEN MEDICAL GROUP ” Practice Location

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