Provider Demographics
NPI:1932722709
Name:MOON, JIYONG
Entity type:Individual
Prefix:
First Name:JIYONG
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 PIERMONT RD # D1-A
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-3137
Mailing Address - Country:US
Mailing Address - Phone:201-741-9737
Mailing Address - Fax:201-479-0312
Practice Address - Street 1:580 PIERMONT RD # D1-A
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-3137
Practice Address - Country:US
Practice Address - Phone:201-741-9737
Practice Address - Fax:201-479-0312
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00161700171100000X
NY006252171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist