Michael Moon MD a Medical Corporation

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

A61865 Issued in CA

Legal business name

MICHAEL MOON MD A MEDICAL CORPORATION

Doing business as

PainCare of San Diego, AMC

Practice address

5348 Carroll Canyon Rd
Suite 101
San Diego, CA 92121-1733

Phone

(858) 202-1546

Fax

(858) 202-1548

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Moon, M.D.NPI 1619014230

Title

Ceo

Phone

(858) 202-1546

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• PainCare of San Diego, AMC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Moon, M.D.

  • Interventional Pain Medicine Physician
  • San Diego, CA
  • NPI 1619014230
  Medicare reassignment Care Compare group NPD Authorized official
• Saiyun Hou, M.D., PH.D

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • San Diego, CA
  • NPI 1326464660
  Medicare reassignment Care Compare group NPD
• Van John Nguyen, PH.D.

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1063630770
  Medicare reassignment NPD
• My-Uyen Diep Nguyen

  • Physician Assistant
  • San Diego, CA
  • NPI 1831822527
  Medicare reassignment
• Danny Song, D.C.

  • Occupational Health Chiropractor
  • San Diego, CA
  • NPI 1629189857
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1629023387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5348 CARROLL CANYON RD",
            "address_2": "SUITE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211733",
            "telephone_number": "858-202-1546",
            "fax_number": "858-202-1548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5348 CARROLL CANYON RD",
            "address_2": "SUITE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211733",
            "telephone_number": "858-202-1546",
            "fax_number": "858-202-1548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL MOON MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-202-1546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "A61865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR009670",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "127169100",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07215Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PainCare of San Diego, AMC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PainCare of San Diego, AMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Michael R. Reider, PH.D., Apc
• Michael Ratter, M.D., a Professional Corporation
• Michael S Bongiovanni MD Inc
• Michael S Duffy Sr DO Inc (Pacific Medical Care)

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.