Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS040106 | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 34932 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS040106 | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | S9191 | TX |
NPI | 1558776088 |
---|---|
Provider Name | Hwi Moon |
First Address | El Paso, TX 79925-7618 |
Second Address | El Paso, TX 79925-7618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 20/06/2021 |