MEDICARE: MOON K YOON, MD INC.

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	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1780707554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON K YOON, MD INC.

Provider Business Mailing Address
First Line	:	PO BOX 74986
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0002
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	:	SYSTEMS ANALYST
Name	:	STEVE RIDDLE
Credential	:
Telephone Number	:	216-383-6480

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	02/02/2010

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