Active NPI
Kyungsik Moon
- General Practice Dentistry
- Bedford, OH
National Provider Identifier
1730569856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 30-024506
- Practice address
- 22301 Rockside Rd
Bedford, OH 44146-1509 - Phone
- (440) 232-4222
- Fax
- (440) 374-5279
- NPI assigned
- Jun 3, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30-024506 | OH | Primary |
Addresses
Primary practice location
22301 Rockside Rd
Bedford, OH 44146-1509
Mailing address
22301 Rockside Rd
Bedford, OH 44146-1509
Phone (440) 232-4222
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-024506 | OH | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hope Dental, LLC | General Practice | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Lynnwood, WA
- NPI 1114545886
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433289600000",
"number": "1730569856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22301 ROCKSIDE RD",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441461509",
"telephone_number": "440-232-4222",
"fax_number": "440-374-5279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22301 ROCKSIDE RD",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441461509",
"telephone_number": "440-232-4222",
"fax_number": "440-374-5279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "KYUNGSIK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-03",
"last_updated": "2015-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "30-024506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.