Provider Demographics
NPI:1093837155
Name:MOON, WON (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:WON
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:333 W BASTANCHURY RD
Mailing Address - Street 2:#100
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3420
Mailing Address - Country:US
Mailing Address - Phone:714-253-5333
Mailing Address - Fax:714-459-8326
Practice Address - Street 1:333 W BASTANCHURY RD
Practice Address - Street 2:#100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3420
Practice Address - Country:US
Practice Address - Phone:714-253-5333
Practice Address - Fax:714-459-8326
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0377611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics