Provider Demographics
NPI:1013401975
Name:ROBERT H MOON MD, INC
Entity Type:Organization
Organization Name:ROBERT H MOON MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HAHN
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-800-6713
Mailing Address - Street 1:1030 WHITE ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2611
Mailing Address - Country:US
Mailing Address - Phone:619-800-6713
Mailing Address - Fax:619-503-9000
Practice Address - Street 1:1030 WHITE ALDER AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-2611
Practice Address - Country:US
Practice Address - Phone:619-800-6713
Practice Address - Fax:619-503-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A76947207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty