Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | D070594 | MD |
Y | 207VE0102X | Reproductive Endocrinologist | MD037731 | DC |
NPI | 1013165273 |
---|---|
Provider Name | Kimberly Suzanne Moon |
First Address | Washington, DC 20006-1003 |
Second Address | Washington, DC 20006-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 28/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156290YT2 | (02) | DC |