Individual provider Active NPI

Sukyung Moon

  • Dentist
  • Greenville, NC
National Provider Identifier
1225766033
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0249 Issued in NC
Practice address
1851 Macgregor Downs Rd
Greenville, NC 27834-5925
Phone
(252) 737-7000
NPI assigned
Aug 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0249 NC Primary

Addresses

Primary practice location

1851 Macgregor Downs Rd
Greenville, NC 27834-5925

Mailing address

1851 Macgregor Downs Rd
Greenville, NC 27834-5925
Phone (252) 737-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221110001199 NC Practitioner - Dentist 0648647289 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0249NCMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina University Current Accepting new patients
East Carolina University CurrentSince Oct 17, 2022 Accepting new patients
East Carolina University Dentist CurrentSince Oct 17, 2022 Accepting new patients

Locations

1851 Macgregor Downs Rd
Greenville, NC 27834
Phone (252) 737-7000

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1225766033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 MACGREGOR DOWNS RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278345925",
            "telephone_number": "252-737-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 MACGREGOR DOWNS RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278345925",
            "telephone_number": "252-737-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "SUKYUNG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-10",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "0249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.