Individual
MOON SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1155 MILL ST, RENO, NV 89502
(775) 982-7878
(775) 982-4196
Mailing address
850 HARVARD WAY, RENO, NV 89502-2055
(775) 982-5262
(775) 982-5496
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11923
NV
208M00000X
Hospitalist Physician
Primary
11923
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11655444
CAQH
—
05
—
1184640542
—
NV
01
—
P00955337
RR MEDICARE
NV
Enumeration date
07/15/2006
Last updated
07/06/2018
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