Provider Demographics
NPI:1679349120
Name:MOON, GA HYUN (LAC)
Entity Type:Individual
Prefix:
First Name:GA HYUN
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 US HIGHWAY 46 STE 300
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6836
Mailing Address - Country:US
Mailing Address - Phone:862-666-9285
Mailing Address - Fax:
Practice Address - Street 1:155 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6831
Practice Address - Country:US
Practice Address - Phone:862-666-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00168500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist