Provider Demographics
NPI:1396174462
Name:MOON, YONGHWA (MD)
Entity type:Individual
Prefix:MR
First Name:YONGHWA
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:YONG WHA
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1515 HOLCOMBE BLVD.
Mailing Address - Street 2:UNIT 455
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4009
Mailing Address - Country:US
Mailing Address - Phone:713-563-0449
Mailing Address - Fax:713-792-0334
Practice Address - Street 1:1400 HOLCOMBE BLVD - UNIT 455
Practice Address - Street 2:FC8. 3000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-563-0449
Practice Address - Fax:713-792-0334
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program