MEDICARE: MR. JI WEON MOON ACUPUNCTURIST

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	171100000X	Acupuncturist	AC17133	CA
2	171100000X	Acupuncturist	OM000224	PA

General Provider Information

NPI Number	:	1669928263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JI WEON MOON ACUPUNCTURIST

Provider Business Mailing Address
First Line	:	2002 NAOMIS CT
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2014
Country	:	US
Telephone Number	:	267-379-6424
Fax Number	:	215-583-8177

Provider Business Practice Location Address
First Line	:	1222 WELSH RD STE B5
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2059
Country	:	US
Telephone Number	:	267-379-6424
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	06/20/2023

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