Provider Demographics
NPI:1578274718
Name:MOON, JIHYUN (CRNP)
Entity Type:Individual
Prefix:
First Name:JIHYUN
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7759 NEW PROVIDENCE DR APT 41
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4422
Mailing Address - Country:US
Mailing Address - Phone:703-615-7573
Mailing Address - Fax:
Practice Address - Street 1:14955 SHADY GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8728
Practice Address - Country:US
Practice Address - Phone:301-990-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily