Provider Demographics
NPI:1740743855
Name:MOON, SANG J (NP)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:J
Last Name:MOON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 OLD YORK RD STE D
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1423
Mailing Address - Country:US
Mailing Address - Phone:215-635-3151
Mailing Address - Fax:215-635-3165
Practice Address - Street 1:8118 OLD YORK RD STE D
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1423
Practice Address - Country:US
Practice Address - Phone:215-635-3151
Practice Address - Fax:215-635-3165
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019643363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology