Provider Demographics
NPI:1801470513
Name:MIHYU, MOODY (MD)
Entity type:Individual
Prefix:DR
First Name:MOODY
Middle Name:
Last Name:MIHYU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9137 RIDGELINE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2397
Mailing Address - Country:US
Mailing Address - Phone:303-649-3140
Mailing Address - Fax:
Practice Address - Street 1:9137 RIDGELINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2397
Practice Address - Country:US
Practice Address - Phone:303-649-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.69906207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine