Provider Demographics
NPI:1669928263
Name:MOON, JI WEON (ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:JI WEON
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 NAOMIS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2014
Mailing Address - Country:US
Mailing Address - Phone:267-379-6424
Mailing Address - Fax:215-583-8177
Practice Address - Street 1:1222 WELSH RD STE B5
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2059
Practice Address - Country:US
Practice Address - Phone:267-379-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17133171100000X
PAOM000224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist