Individual
DR. MICHAEL MOON
Active
Individual
DR. MICHAEL MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
A61865
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127169100
ACS-US DEPT OF LABOR
CA
01
—
330992123
BLUE CROSS
CA
01
—
A61865
LICENSE NUMBER
CA
05
—
GR0096070
—
CA
01
—
P00302519
RAIL ROAD MEDICARE
CA
01
—
ZZZ07215Z
BLUE SHIELD
CA
Enumeration date
01/31/2007
Last updated
09/24/2012
Update your record
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