Provider Demographics
NPI:1083332530
Name:MOON HEALING ACUPUNCTURE & INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:MOON HEALING ACUPUNCTURE & INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOON
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:ACU
Authorized Official - Phone:240-416-0612
Mailing Address - Street 1:11269 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1518
Mailing Address - Country:US
Mailing Address - Phone:240-416-0612
Mailing Address - Fax:
Practice Address - Street 1:11269 OLD FREDERICK RD
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1518
Practice Address - Country:US
Practice Address - Phone:240-416-0612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty