Provider Demographics
NPI:1477598910
Name:MOON, HANHEY (MD)
Entity Type:Individual
Prefix:MS
First Name:HANHEY
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 WHITE LANE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307
Mailing Address - Country:US
Mailing Address - Phone:661-835-2600
Mailing Address - Fax:661-835-2603
Practice Address - Street 1:1491 WHITE LANE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307
Practice Address - Country:US
Practice Address - Phone:661-835-2600
Practice Address - Fax:661-835-2603
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61306208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A613060Medicaid
CA00A613060Medicaid
CAWA61306BMedicare PIN