Provider Demographics
NPI:1831194976
Name:CHOI - CHUNG, MOON S (MD)
Entity type:Individual
Prefix:DR
First Name:MOON
Middle Name:S
Last Name:CHOI - CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5171
Mailing Address - Country:US
Mailing Address - Phone:828-586-7448
Mailing Address - Fax:828-586-5507
Practice Address - Street 1:74 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5171
Practice Address - Country:US
Practice Address - Phone:828-586-7448
Practice Address - Fax:828-586-5507
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24571170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC86577Medicare UPIN