Provider Demographics
NPI:1366420952
Name:YOON, MOON K (MD)
Entity type:Individual
Prefix:
First Name:MOON
Middle Name:K
Last Name:YOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOON
Other - Middle Name:K
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:224 PARRISH RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2013
Mailing Address - Country:US
Mailing Address - Phone:440-599-1024
Mailing Address - Fax:440-599-9590
Practice Address - Street 1:224 PARRISH RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2013
Practice Address - Country:US
Practice Address - Phone:440-599-1024
Practice Address - Fax:440-599-9590
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100275Y174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist