Provider Demographics
NPI:1710978952
Name:MOON, DONG YEON (MD)
Entity Type:Individual
Prefix:MR
First Name:DONG
Middle Name:YEON
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:35000 DIVISION RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1566
Mailing Address - Country:US
Mailing Address - Phone:586-727-7209
Mailing Address - Fax:586-727-7929
Practice Address - Street 1:35000 DIVISION RD
Practice Address - Street 2:SUITE 9
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1566
Practice Address - Country:US
Practice Address - Phone:586-727-7209
Practice Address - Fax:586-727-7929
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDM034395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC3196OtherM-CARE
MI1105044541OtherBLUE CROSS
MI2092217Medicaid
110223882OtherRAILROAD MEDICARE
4035060OtherAETNA
102813OtherPREFERRED CHOICES
D91391OtherHAP
110223882OtherRAILROAD MEDICARE
MI2092217Medicaid