Provider Demographics
NPI:1154524973
Name:NAM, MOON WOO (MD)
Entity type:Individual
Prefix:
First Name:MOON WOO
Middle Name:
Last Name:NAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOON-WOO
Other - Middle Name:
Other - Last Name:NAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-907-3969
Mailing Address - Fax:630-907-3998
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1404
Practice Address - Country:US
Practice Address - Phone:630-859-8700
Practice Address - Fax:630-264-8478
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49908-020207ZP0102X
IL036.136194207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology