Basic Information
| Provider Information | |||||||||
| NPI: | 1003004946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOON | ||||||||
| FirstName: | EDDIE | ||||||||
| MiddleName: | JOOHYUN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DAOM, L.AC. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOON | ||||||||
| OtherFirstName: | JOO HYUN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | DAOM, L.AC. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 758 E COLORADO BLVD | ||||||||
| Address2: | STE.201 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911012127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132683007 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 758 E COLORADO BLVD | ||||||||
| Address2: | STE.201 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911012127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132683007 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC 11179 | CA | Y | Other Service Providers | Acupuncturist |
No ID Information.