Eun Sang Moon, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE61330238 Issued in WA

Practice address

17707 W Main St
Monroe, WA 98272-1967

Phone

(602) 823-9003

Fax

(360) 282-3907

NPI assigned

Feb 8, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Monroe, WA
  • NPI 1942626072
  NPD
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Monroe, WA
  • NPI 1508049008
  NPD (past)

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1801395538",
    "addresses": [
        {
            "country_code": "KR",
            "country_name": "Korea, Republic of",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "85-60HO, SANGBONG-DONG",
            "city": "SEOUL",
            "state": "JUNGRANG-GU",
            "postal_code": "02152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17707 W MAIN ST",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721967",
            "telephone_number": "602-823-9003",
            "fax_number": "360-282-3907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 W 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "43210",
            "country_code": "US",
            "telephone_number": "614-701-8648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOON",
        "first_name": "EUN SANG",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-08",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.024728",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE61330238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30.024728",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monroe Therapeutic Massage PS
• Monroe Vision Clinic, Inc
• Monroe Womens Care, PC
• Margot Ann Montel - Westover, LMP
• Joshua Jason Montemayor, PA-C
• Heidi Sue Moore, LMP
• Loryn Elizabeth Moore
• Beena L. Morris, MD
• Jennifer Kathleen Morrison, LMP
• Joshua Wayne Morrison, PA-C

• Orthodontics and Dentofacial Orthopedics Dentistry in Monroe, WA
• Providers in Monroe, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.