Provider Demographics
NPI:1851024921
Name:MOON, JOYCE (RD, RDN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 NE 9TH PL UNIT 1421
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5071
Mailing Address - Country:US
Mailing Address - Phone:425-531-3342
Mailing Address - Fax:
Practice Address - Street 1:10650 NE 9TH PL UNIT 1421
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5071
Practice Address - Country:US
Practice Address - Phone:425-531-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60796251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered