Provider Demographics
NPI:1134395478
Name:MOON, KEVIN SUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SUNG
Last Name:MOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SYLVAN AVE
Mailing Address - Street 2:SUITE #D
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2431
Mailing Address - Country:US
Mailing Address - Phone:201-346-0755
Mailing Address - Fax:201-346-0759
Practice Address - Street 1:6 SYLVAN AVE
Practice Address - Street 2:SUITE #D
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2431
Practice Address - Country:US
Practice Address - Phone:201-346-0755
Practice Address - Fax:201-346-0759
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI203021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice