Kenneth H Moon Jr, DO

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

02033 Issued in IA

Practice address

2301 East 14TH Street
Des Moines, IA 50316-1901

Phone

(515) 262-0404

Fax

(515) 262-0489

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344470400000",
    "number": "1447226840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 E 14TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503161901",
            "telephone_number": "515-262-0404",
            "fax_number": "515-262-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 EAST 14TH STREET",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503161901",
            "telephone_number": "515-262-0404",
            "fax_number": "515-262-0489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON JR",
        "first_name": "KENNETH",
        "middle_name": "H",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2012-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "IA",
            "license": "02033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447226840",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2215236",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa Patricia Monsod Borromeo, MD
• Davina Noel Monson, PHARMD
• Lorie A. Montag, M.D.
• Andrea Joy Montgomery, DDS
• Brianna Mooers, DPT
• Moonstone Counseling PLLC
• Stephen James Mooradian, M.D.
• Alexander Duncan Moore, M.D.
• Amanda Fowler Moore, M.A., CCC-SLP
• Cole Douglas Moore, DO

• Addiction Medicine (Family Medicine) Physician in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Addiction Medicine (Family Medicine) Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.