Provider Demographics
NPI:1023390382
Name:MOON, KYONG-HWA (DMD)
Entity Type:Individual
Prefix:
First Name:KYONG-HWA
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-5101
Mailing Address - Country:US
Mailing Address - Phone:315-697-9321
Mailing Address - Fax:
Practice Address - Street 1:3167 SENECA TPKE
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-5101
Practice Address - Country:US
Practice Address - Phone:315-697-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96001223G0001X
NY0635691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice