Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 263532 | NY |
N | 208200000X | Surgeon | 263532 | NY |
N | 208600000X | Surgeon | 263532 | NY |
NPI | 1639135890 |
---|---|
Provider Name | Jang I. Moon |
First Address | New York, NY 10029-6574 |
Second Address | New York, NY 10029-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 16/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03179137 | (05) | NY |