NPIMap

Individual provider Active NPI

John T Moon, MD, PHD

  • Surgery Physician
  • Astoria, OR
National Provider Identifier
1558456319
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD156549 Issued in OR
Practice address
2055 Exchange St Ste 270
Astoria, OR 97103-3419
Phone
(503) 338-4670
NPI assigned
Oct 4, 2006
Last updated
Aug 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 0440321 KS
Surgery Physician 208600000X MD156549 OR Primary

Addresses

Primary practice location

2055 Exchange St Ste 270
Astoria, OR 97103-3419

Mailing address

2111 Exchange St
Astoria, OR 97103-3329
Phone (503) 325-4321

Other practice location 1

9301 W 74th St Ste 110
Merriam, KS 66204-2207
Phone (913) 632-9200

Other practice location 2

3660 Park Sierra Dr
Suite 105
Riverside, CA 92505-3081
Phone (661) 304-8539

Other identifiers 1

IdentifierTypeStateIssuer
6603700MedicaidNY

Other names 1

  • Dr. John Tae Sung Moon Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MD, OR3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20091014000646 CA Practitioner - General Surgery 9739105735 Reassigns benefits to 2 organizations
I20200428000225 MD Practitioner - General Surgery 9739105735 Reassigns benefits to 1 organization
I20240912004041 OR Practitioner - General Surgery 9739105735 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Louisiana State University School of Medicine in New Orleans, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Lutheran CharitiesGroup PAC ID 5294643359, shared by 8 NPIs, 110 clinicians

Practice addresses (Care Compare)

2055 Exchange St
Suite 270
Astoria, OR 97103-3419
Phone (503) 338-4670

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0440321KSMDSurgery Physician
MD156549ORMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Lutheran Charities CurrentSince Oct 1, 2024 Accepting new patients
Mission Surgical Clinic, Inc. Surgery CurrentSince Jun 1, 2012 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Mar 30, 2020 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Mar 30, 2020 Accepting new patients
Columbia Lutheran Charities Surgery CurrentSince Oct 1, 2024 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
LMC Physician Services, PC Surgery Past Accepting new patients
Mission Surgical Center Inc Past Accepting new patients
Liberty Surgical Associates Surgery Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

2250 S Main St
Ste 206
Corona, CA 92882
Phone (951) 278-8870

3660 Park Sierra Dr
Ste 105
Riverside, CA 92505
Phone (951) 278-8870

36423 Inland Vly Dr
Ste 280
Wildomar, CA 92595

36423 Inland Vly Dr
Ste 280
Wildomar, CA 92595
Phone (951) 278-8870

2540 Centreville Rd
Centreville, MD 21617
Phone (410) 758-4432

219 S Washington St
Easton, MD 21601

500 Cadmus Ln
Ste 205
Easton, MD 21601
Phone (410) 822-4553

301 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4565

900 Elkridge Landing Rd
Fl 2
Linthicum Heights, MD 21090
Phone (443) 462-5010

2055 Exchange St
Ste 270
Astoria, OR 97103
Phone (503) 325-7546

2111 Exchange St
Astoria, OR 97103
Phone (503) 325-4321

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1558456319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 EXCHANGE ST",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033329",
            "telephone_number": "503-325-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 EXCHANGE ST STE 270",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033419",
            "telephone_number": "503-338-4670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9301 W 74th St Ste 110",
            "address_purpose": "LOCATION",
            "city": "Merriam",
            "state": "KS",
            "postal_code": "662042207",
            "country_code": "US",
            "telephone_number": "913-632-9200",
            "fax_number": "913-632-9209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3660 Park Sierra Dr",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925053081",
            "country_code": "US",
            "telephone_number": "661-304-8539",
            "fax_number": "951-278-8913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOON",
        "first_name": "JOHN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KS",
            "license": "0440321",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD156549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603700",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "MOON",
            "middle_name": "TAE SUNG",
            "prefix": "DR.",
            "credential": "MD, PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Astoria, OR

Sources for this page

Verify at the official NPI Registry.