Active NPI
Daeuk Moon
- Dentist
- Philadelphia, PA
National Provider Identifier
1295987451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS037680
- Practice address
- 8115 Ridge Ave
Philadelphia, PA 19128-2901 - Phone
- (215) 487-2347
- Fax
- (215) 487-1459
- NPI assigned
- Oct 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS037680 | PA | Primary |
Addresses
Primary practice location
8115 Ridge Ave
Philadelphia, PA 19128-2901
Mailing address
8115 Ridge Ave
Philadelphia, PA 19128-2901
Phone (215) 487-2347
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS037680 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Line Dental | Past | Accepting new patients | |
| Elkins Park Dental, Inc. | 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.
-
- Dental Clinic/Center
- Elkins Park, PA
- NPI 1316392566
-
- General Practice Dentistry
- Philadelphia, PA
- NPI 1609171388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361923200000",
"number": "1295987451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8115 RIDGE AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191282901",
"telephone_number": "215-487-2347",
"fax_number": "215-487-1459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8115 RIDGE AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191282901",
"telephone_number": "215-487-2347",
"fax_number": "215-487-1459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "DAEUK",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-21",
"last_updated": "2013-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS037680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.