Provider Demographics
NPI:1366415309
Name:MOON, SCOTT DM (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DM
Last Name:MOON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:THE QUEEN'S MEDICAL CENTER DEPT OF RAD ONC
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2402
Mailing Address - Country:US
Mailing Address - Phone:808-691-4771
Mailing Address - Fax:808-691-4507
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:THE QUEEN'S MEDICAL CENTER DEPT OF RAD ONC
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-691-4771
Practice Address - Fax:808-691-4507
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2025-05-29
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Provider Licenses
StateLicense IDTaxonomies
SCMD934022085R0001X
HI79012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF95536OtherHMSA
HI07351208Medicaid
HIF37086Medicare UPIN
HI07351208Medicaid