Individual
EUN SANG MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
17707 W MAIN ST, MONROE, WA 98272-1967
(602) 823-9003
(360) 282-3907
Mailing address
85-60HO, SANGBONG-DONG, SEOUL, JUNGRANG-GU 02152
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30.024728
OH
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE61330238
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30.024728
—
OH
Enumeration date
02/08/2018
Last updated
08/29/2024
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