Provider Demographics
NPI:1336420165
Name:MOON, HONG BEOM (DDS, MS, FICD)
Entity type:Individual
Prefix:DR
First Name:HONG
Middle Name:BEOM
Last Name:MOON
Suffix:
Gender:M
Credentials:DDS, MS, FICD
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Mailing Address - Street 1:3700 WILSHIRE BLVD STE 770
Mailing Address - Street 2:SMILE WORLD ORTHODONTICS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3008
Mailing Address - Country:US
Mailing Address - Phone:213-365-2828
Mailing Address - Fax:213-365-2822
Practice Address - Street 1:3700 WILSHIRE BLVD STE 770
Practice Address - Street 2:SMILE WORLD ORTHODONTICS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3008
Practice Address - Country:US
Practice Address - Phone:213-365-2828
Practice Address - Fax:213-365-2822
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA380951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics