Provider Demographics
NPI:1669722658
Name:MOON, JAKE HYUN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:HYUN
Last Name:MOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26795 US HIGHWAY 380 E STE 400
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7895
Mailing Address - Country:US
Mailing Address - Phone:972-347-6200
Mailing Address - Fax:
Practice Address - Street 1:26795 US HIGHWAY 380 E STE 400
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-7895
Practice Address - Country:US
Practice Address - Phone:972-347-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice