Individual
INNKYU MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1701 SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
030027
NY
363A00000X
Physician Assistant
Primary
10005244A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104362029
ANTHEM PTAN
IN
Enumeration date
07/26/2022
Last updated
06/02/2026
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