Dong Yeon Moon, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DM034395 Issued in MI

Practice address

35000 Division Rd
Suite 9
Richmond, MI 48062-1566

Phone

(586) 727-7209

Fax

(586) 727-7929

NPI assigned

Nov 4, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Great Lakes Internist PC

  • Internal Medicine Physician
  • Richmond, MI
  • NPI 1962555227
  NPD (past)

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261353600000",
    "number": "1710978952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35000 DIVISION RD",
            "address_2": "SUITE 9",
            "city": "RICHMOND",
            "state": "MI",
            "postal_code": "480621566",
            "telephone_number": "586-727-7209",
            "fax_number": "586-727-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35000 DIVISION RD",
            "address_2": "SUITE 9",
            "city": "RICHMOND",
            "state": "MI",
            "postal_code": "480621566",
            "telephone_number": "586-727-7209",
            "fax_number": "586-727-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "DONG",
        "middle_name": "YEON",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2009-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "DM034395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE",
            "identifier": "C3196",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1105044541",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2092217",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110223882",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4035060",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "102813",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "D91391",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather A Miller, L.P.C., L.B.S.W.
• Alaina Miron, DPT
• Tina L Mizla
• Marissa Molinaro, PT
• Hengelberth D Montufar, D.P.M.
• Gary Raymond Mose
• Katianne Rose Murphy
• Sreekant S Nair, DO
• Andrea Eileen Naylor, CPRC
• New Image Dental, P.C.

• Internal Medicine Physician in Richmond, MI
• Providers in Richmond, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.