Individual
KYOUNG MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(201) 943-0034
(201) 943-8105
Mailing address
PO BOX 724, MILLBURN, NJ 07041-0724
(201) 943-0034
(201) 943-8105
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA03401700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4837703
—
NJ
01
—
D92539
UNIVERSAL PROVIDER NUMBER
NJ
Enumeration date
01/25/2006
Last updated
01/31/2020
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