Active NPI
Chang Won Moon, MD
- Military Health Care Provider
National Provider Identifier
1053479964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- 193368
- Practice address
- B Co 168 Med BN
Apo, AP 96205
KR - Phone
- (315) 741-6650
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 193368 | NY | Primary |
Addresses
Primary practice location
B Co 168 Med BN
Apo, AP 96205
KR
Mailing address
B Co 168 Med BN
Apo, AP 96205
KR
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 187625 | NY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ji Han, MD, PLLC | Past | Accepting new patients | |
| CMC Housestaff | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Elmhurst, NY
- NPI 1063572212
-
- Pain Clinic/Center
- Flushing, NY
- NPI 1710001359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053479964",
"addresses": [
{
"country_code": "KR",
"country_name": "Korea, Republic of",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "B CO 168 MED BN",
"city": "APO",
"state": "AP",
"postal_code": "96205"
},
{
"country_code": "KR",
"country_name": "Korea, Republic of",
"address_purpose": "LOCATION",
"address_type": "FGN",
"address_1": "B CO 168 MED BN",
"city": "APO",
"state": "AP",
"postal_code": "96205",
"telephone_number": "315-741-6650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "CHANG",
"middle_name": "WON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "NY",
"license": "193368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.