Provider Demographics
NPI:1215019609
Name:MOON, JUSTIN SUK JOO (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:SUK JOO
Last Name:MOON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE STE 570
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7003
Mailing Address - Country:US
Mailing Address - Phone:303-715-9024
Mailing Address - Fax:303-715-5020
Practice Address - Street 1:950 E HARVARD AVE STE 570
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210
Practice Address - Country:US
Practice Address - Phone:303-715-9024
Practice Address - Fax:303-715-5020
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00465842084N0400X
MN500762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71524011Medicaid