Provider Demographics
NPI:1669277869
Name:MOOYOUNG, DAVID (LMBT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MOOYOUNG
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 WILKINS ST
Mailing Address - Street 2:
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027-2056
Mailing Address - Country:US
Mailing Address - Phone:509-310-9421
Mailing Address - Fax:
Practice Address - Street 1:1819 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7901
Practice Address - Country:US
Practice Address - Phone:509-310-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10030225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist