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Individual

DR. KYUNG-WOONG MOON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1096 S BELSAY RD, SUITE J, BURTON, MI 48509-1948
(810) 715-0803
(810) 715-0824
Mailing address
3495 S CENTER RD, BURTON, MI 48519-1455
(810) 424-2007
(810) 743-1099

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301034878
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3008204811
BCBSM INDIVIDUAL PIN
MI
05
4765404
MI
Enumeration date
08/01/2006
Last updated
09/20/2007
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