Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A63715 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A63715 | CA |
NPI | 1376527440 |
---|---|
Provider Name | Dr. Charles Moon |
First Address | Los Angeles, CA 90051-0717 |
Second Address | Los Angeles, CA 90048-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 08/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82290 | (02) | CA |