Provider Demographics
NPI:1033550199
Name:MOON, YOODONG (DDS)
Entity Type:Individual
Prefix:
First Name:YOODONG
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830N PULASKI RD 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2847
Mailing Address - Country:US
Mailing Address - Phone:773-283-2100
Mailing Address - Fax:
Practice Address - Street 1:3901 OLD SEWARD HWY
Practice Address - Street 2:12-A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6089
Practice Address - Country:US
Practice Address - Phone:909-991-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist