Provider Demographics
NPI:1437378049
Name:MOON, STEVE (DC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 BARRANCA PKWY
Mailing Address - Street 2:SUITE #244
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:949-552-7006
Practice Address - Street 1:28000 S WESTERN AVE UNIT 427
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-1212
Practice Address - Country:US
Practice Address - Phone:424-473-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28583111N00000X
CA304209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00772Medicare UPIN
CADC28583Medicare ID - Type Unspecified