Individual
KENNETH TAEHO MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24435 MERVELL DEAN RD, HOLLYWOOD, MD 20636-2712
(301) 373-2116
Mailing address
PO BOX 37, HOLLYWOOD, MD 20636-0037
(301) 373-2116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
32929
DC
207Q00000X
Family Medicine Physician
Primary
D0057219
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080185963
MEDICARE RR
DC
Enumeration date
10/11/2005
Last updated
10/24/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us