Provider Demographics
NPI:1346987732
Name:MOON, STEVEN DONGHUN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DONGHUN
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 1:6735 HUNTING PATH RD
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2957
Mailing Address - Country:US
Mailing Address - Phone:703-754-2300
Mailing Address - Fax:
Practice Address - Street 1:6735 HUNTING PATH RD
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2957
Practice Address - Country:US
Practice Address - Phone:703-754-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014179411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice