Provider Demographics
NPI:1598180689
Name:DAI OK MOON MD PA
Entity Type:Organization
Organization Name:DAI OK MOON MD PA
Other - Org Name:ST FRANCIS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAI
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:302-731-0600
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 1:701 NORTH CLAYTON STREET
Practice Address - Street 2:ST FRANCIS HOSPITAL
Practice Address - City:WIMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-731-0600
Practice Address - Fax:302-731-0605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAI OK MOON MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-26
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002324207X00000X
DEC1-0002324282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE070989Medicare UPIN