MEDICARE: MOON K YOON 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	174400000X	Specialist	35100275Y	OH

General Provider Information

NPI Number	:	1366420952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOON K YOON MD

Provider Business Mailing Address
First Line	:	224 PARRISH RD
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2013
Country	:	US
Telephone Number	:	440-599-1024
Fax Number	:	440-599-9590

Provider Business Practice Location Address
First Line	:	224 PARRISH RD
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2013
Country	:	US
Telephone Number	:	440-599-1024
Fax Number	:	440-599-9590

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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Directions to “ MOON K YOON MD” Practice Location

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