Individual
DR. THEODORE HYUNSUB MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1380 E MEDICAL CENTER DR, SUITE 2200, ST GEORGE, UT 84790-2123
(435) 251-2600
(435) 251-2610
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 251-2600
(435) 251-2610
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
8288624-8017
UT
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A60692
CA
207RP1001X
Pulmonary Disease Physician
Primary
8288624-8017
UT
207RP1001X
Pulmonary Disease Physician
A60692
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A606920
—
CA
Enumeration date
02/28/2006
Last updated
08/02/2012
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