Provider Demographics
NPI:1073822078
Name:MOON, YOUNG SUN (LAC)
Entity Type:Individual
Prefix:MS
First Name:YOUNG SUN
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PARK PL APT 1A
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3705
Mailing Address - Country:US
Mailing Address - Phone:201-982-0615
Mailing Address - Fax:
Practice Address - Street 1:344 LINCOLN AVE # RR
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1258
Practice Address - Country:US
Practice Address - Phone:201-503-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00070900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist