Provider Demographics
NPI:1740526763
Name:MOON, SEUNG-HEE (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:
First Name:SEUNG-HEE
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:23530 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4765
Mailing Address - Country:US
Mailing Address - Phone:424-903-7007
Mailing Address - Fax:424-903-7009
Practice Address - Street 1:23530 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4765
Practice Address - Country:US
Practice Address - Phone:424-903-7007
Practice Address - Fax:424-903-7009
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22819363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical