Provider Demographics
NPI:1194154815
Name:MOON, SEONG HOON (DPT)
Entity type:Individual
Prefix:DR
First Name:SEONG HOON
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4076
Mailing Address - Country:US
Mailing Address - Phone:516-672-2886
Mailing Address - Fax:718-699-6660
Practice Address - Street 1:9046 CORONA AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4076
Practice Address - Country:US
Practice Address - Phone:516-672-2886
Practice Address - Fax:718-463-6392
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist