Provider Demographics
NPI:1003004946
Name:MOON, EDDIE JOOHYUN (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:JOOHYUN
Last Name:MOON
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:JOO HYUN
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DAOM, LAC
Mailing Address - Street 1:758 E COLORADO BLVD
Mailing Address - Street 2:STE.201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2127
Mailing Address - Country:US
Mailing Address - Phone:213-268-3007
Mailing Address - Fax:
Practice Address - Street 1:758 E COLORADO BLVD
Practice Address - Street 2:STE.201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2127
Practice Address - Country:US
Practice Address - Phone:213-268-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11179171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist