Provider Demographics
NPI:1639135890
Name:MOON, JANG I (MD)
Entity type:Individual
Prefix:
First Name:JANG
Middle Name:I
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-659-9300
Mailing Address - Fax:212-241-2064
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:12TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-659-9300
Practice Address - Fax:212-241-2064
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-05-16
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Provider Licenses
StateLicense IDTaxonomies
NY263532208600000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03179137Medicaid
NY03179137Medicaid