Provider Demographics
NPI:1376537746
Name:MOON, DAI OK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAI
Middle Name:OK
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C-83 OMEGA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-731-0600
Mailing Address - Fax:302-731-0605
Practice Address - Street 1:C-83 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-731-0600
Practice Address - Fax:302-731-0605
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002324207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE070989Medicare PIN
D76769Medicare UPIN