Provider Demographics
NPI:1619276920
Name:MOON, JIHUN (DDS)
Entity Type:Individual
Prefix:
First Name:JIHUN
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3939
Mailing Address - Country:US
Mailing Address - Phone:704-983-2131
Mailing Address - Fax:704-983-2132
Practice Address - Street 1:255 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3939
Practice Address - Country:US
Practice Address - Phone:704-983-2131
Practice Address - Fax:704-983-2132
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist