Kyung-Woong Moon, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4301034878 Issued in MI

Practice address

1096 S Belsay Rd
Suite J
Burton, MI 48509-1948

Phone

(810) 715-0803

Fax

(810) 715-0824

NPI assigned

Aug 1, 2006

Last updated

Sep 20, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Allen Park Family Physicians PLC

  • Family Medicine Physician
  • Allen Park, MI
  • NPI 1265930275
  NPD (past)
• Eastpointe Radiologists, P.C.

  dba Grosse Pointe Physicians Xray Center, PC

  • Diagnostic Radiology Physician
  • Detroit, MI
  • NPI 1881642056
  NPD (past)
• Eastpointe Radiologists, PC

  dba Grosse Pointe Physicians Xray Center, PC

  • Diagnostic Radiology Physician
  • Grosse Pointe Woods, MI
  • NPI 1558409649
  NPD (past)
• Genesys Integrated Group Practice PC

  • Nurse Practitioner
  • Flint, MI
  • NPI 1386782381
  NPD (past)
• Genesys Integrated Group Practice PC

  • Family Medicine Physician
  • Burton, MI
  • NPI 1912956723

  Diagnostic Radiology

  NPD (past)
• Suburban Dianostics PLLC

  • Diagnostic Radiology Physician
  • Lincoln Park, MI
  • NPI 1992743801
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1831106301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191455",
            "telephone_number": "810-424-2007",
            "fax_number": "810-743-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 S BELSAY RD",
            "address_2": "SUITE J",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091948",
            "telephone_number": "810-715-0803",
            "fax_number": "810-715-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "KYUNG-WOONG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301034878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM INDIVIDUAL PIN",
            "identifier": "3008204811",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4765404",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roger Mims Jr.
• Ardelia Mincey
• Ciera Marquel Mitchell
• Devonia Kaye Mitchell
• Dylan Nicholas Mooken, MD
• William H Moon Jr., DDS
• David Neil Moore, O.D.
• Scott James Moore, O.D.
• Katelyn Marie Morgner, FNP
• Destiny Morris

• Diagnostic Radiology Physician in Burton, MI
• Providers in Burton, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; 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.