Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 74207 | GA |
NPI | 1043455306 |
---|---|
Provider Name | Davis Sungwhan Moon |
First Address | Savannah, GA 31404-6261 |
Second Address | Savannah, GA 31404-6261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 13/09/2019 |