Provider Demographics
NPI:1174756357
Name:MOON M. OH MD, INC
Entity type:Organization
Organization Name:MOON M. OH MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOONMOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-552-8217
Mailing Address - Street 1:3500 BARRANCA PKWY
Mailing Address - Street 2:330
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8226
Mailing Address - Country:US
Mailing Address - Phone:949-552-8217
Mailing Address - Fax:949-809-9514
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:330
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8226
Practice Address - Country:US
Practice Address - Phone:949-552-8217
Practice Address - Fax:949-809-9514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOON M. OH, MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-03
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA107209OtherMEDICAL BOARD OF CALIFORNIA