Provider Demographics
NPI:1043922123
Name:MOON, SEONJO
Entity Type:Individual
Prefix:MR
First Name:SEONJO
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 TWIN KNOLLS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3260
Mailing Address - Country:US
Mailing Address - Phone:267-467-5652
Mailing Address - Fax:
Practice Address - Street 1:5501 TWIN KNOLLS RD STE 111
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3260
Practice Address - Country:US
Practice Address - Phone:240-243-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist