Provider Demographics
NPI:1467059188
Name:JUN, MOON M
Entity Type:Individual
Prefix:
First Name:MOON
Middle Name:M
Last Name:JUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3522
Mailing Address - Country:US
Mailing Address - Phone:917-402-4220
Mailing Address - Fax:
Practice Address - Street 1:320 OLD COUNTRY RD STE 105
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1703
Practice Address - Country:US
Practice Address - Phone:516-739-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist