Provider Demographics
NPI:1083431050
Name:MOON, HYUN KOOK (LD)
Entity type:Individual
Prefix:
First Name:HYUN KOOK
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E WARD ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4537
Mailing Address - Country:US
Mailing Address - Phone:253-656-3784
Mailing Address - Fax:
Practice Address - Street 1:423 E WARD ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4537
Practice Address - Country:US
Practice Address - Phone:253-656-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN61520268122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist