Active NPI
Youngsik Moon, M.D., P.a.
- Family Medicine Physician
- Hollywood, MD
National Provider Identifier
1245447465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- YOUNGSIK MOON, M.D., P.A.
- Practice address
- 24435 Mervell Dean Rd
Hollywood, MD 20636-2712 - Phone
- (301) 373-2116
- Fax
- (301) 373-5281
- NPI assigned
- May 17, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Betty Ann Quade
- Title
- Business Manager
- Phone
- (301) 373-2116
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Surgery Physician | 208600000X | D09178 | MD | |
| General Practice Physician | 208D00000X | D09178 | MD |
Addresses
Primary practice location
24435 Mervell Dean Rd
Hollywood, MD 20636-2712
Mailing address
24435 Mervell Dean Rd
PO Box 37
Hollywood, MD 20636-2712
Phone (301) 373-2116
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1307 | Other | DC | CAREFIRST BCBS OF DC |
| 1010188 | Other | AETNA HMO | |
| 112048 | Other | MD | AMERIGROUP |
| 2120400 | Other | CIGNA | |
| KQ75 | Other | MD | CAREFIRST BCBS OF MD |
| 145464300 | Other | OWCP | |
| DG3783 | Other | MD | RAILRAOD MEDICARE |
| 531541700 | Medicaid | MD | |
| 5972624 | Other | AETNA PPO | |
| 818489 | Other | MAMSI |
Other names 1
- Hollywood Medical Center
National Provider Directory
National Provider DirectoryLocations
24435 Mervell Dean Rd
Hollywood, MD 20636
Phone (301) 373-2116
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Hollywood, MD
- NPI 1821331539
-
- Internal Medicine Physician
- Paradise, CA
- NPI 1588693261
-
- Internal Medicine Physician
- Eustis, FL
- NPI 1629077573
-
- Internal Medicine Physician
- Santa Fe, NM
- NPI 1922134774
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1300924800000",
"number": "1245447465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24435 MERVELL DEAN RD",
"address_2": "PO BOX 37",
"city": "HOLLYWOOD",
"state": "MD",
"postal_code": "206362712",
"telephone_number": "301-373-2116",
"fax_number": "301-373-5281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24435 MERVELL DEAN RD",
"city": "HOLLYWOOD",
"state": "MD",
"postal_code": "206362712",
"telephone_number": "301-373-2116",
"fax_number": "301-373-5281"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "YOUNGSIK MOON, M.D., P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-17",
"last_updated": "2011-03-24",
"status": "A",
"authorized_official_last_name": "QUADE",
"authorized_official_first_name": "BETTY ANN",
"authorized_official_title_or_position": "BUSINESS MANAGER",
"authorized_official_telephone_number": "301-373-2116",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": "MD",
"license": "D09178",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "General Practice",
"state": "MD",
"license": "D09178",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST BCBS OF DC",
"identifier": "1307",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "1010188",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "112048",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2120400",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST BCBS OF MD",
"identifier": "KQ75",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "145464300",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILRAOD MEDICARE",
"identifier": "DG3783",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "531541700",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "5972624",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "818489",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Hollywood Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hollywood, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.