Provider Demographics
NPI:1396594297
Name:MOON, INEON (DN ,LAC, PHD)
Entity type:Individual
Prefix:DR
First Name:INEON
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DN ,LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 CAMPUS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2191
Mailing Address - Country:US
Mailing Address - Phone:213-949-2100
Mailing Address - Fax:
Practice Address - Street 1:5100 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2191
Practice Address - Country:US
Practice Address - Phone:213-949-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist