Provider Demographics
NPI:1730411703
Name:HYE WON MOON D.D.S. INC.
Entity type:Organization
Organization Name:HYE WON MOON D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HYE
Authorized Official - Middle Name:WON
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-732-2828
Mailing Address - Street 1:4026 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2351
Mailing Address - Country:US
Mailing Address - Phone:323-732-2828
Mailing Address - Fax:323-732-9737
Practice Address - Street 1:4026 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3257
Practice Address - Country:US
Practice Address - Phone:323-732-2828
Practice Address - Fax:323-732-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45925126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty