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NPI Code Detail

MEDICARE: JUSTIN MOON

MEDICARE: JUSTIN MOON
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
1390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1790628782
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN MOON
Provider Business Mailing Address
First Line : 23203 BELTED KINGFISHER TRL
Second Line :
City : SPRING
State : TX
Zip : 77389-1594
Country : US
Telephone Number : 630-843-1481
Fax Number :
Provider Business Practice Location Address
First Line : 720 WESTVIEW DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30310-1458
Country : US
Telephone Number : 404-756-1368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ JUSTIN MOON ” Practice Location

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