Provider Demographics
NPI:1922268705
Name:MOON, DANIEL LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEO
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:612 W DUARTE RD STE 804
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9250
Mailing Address - Country:US
Mailing Address - Phone:626-600-2094
Mailing Address - Fax:626-226-5827
Practice Address - Street 1:612 W DUARTE RD STE 804
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9250
Practice Address - Country:US
Practice Address - Phone:626-600-2094
Practice Address - Fax:626-226-5827
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA101915208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery