MEDICARE: RICHARD HYUNG SUNG MOON MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	34377	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356336762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD HYUNG SUNG MOON MD

Provider Business Mailing Address
First Line	:	11 NEVINS ST
Second Line	:	SUITE 306
City	:	BRIGHTON
State	:	MA
Zip	:	02135-3514
Country	:	US
Telephone Number	:	617-789-2045
Fax Number	:	617-789-2932

Provider Business Practice Location Address
First Line	:	11 NEVINS ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-3514
Country	:	US
Telephone Number	:	617-789-2045
Fax Number	:	617-789-2932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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