Individual
TAESUN MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
126 E CHURCH ST STE 2300, SOMERSET, PA 15501-2272
(814) 443-2100
Mailing address
126 E CHURCH ST STE 2300, SOMERSET, PA 15501-2272
(814) 443-2100
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS016770
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS016770
MEDICAL LICENSE
PA
Enumeration date
08/16/2006
Last updated
06/05/2024
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