Stacey Hyun Joo Moon, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

63692 Issued in CA

Practice address

9500 Gilman Dr
La Jolla, CA 92093-5004

Phone

(858) 822-6448

NPI assigned

Aug 20, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1881093300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3141 STEVENS CREEK BLVD # 117",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951171141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 GILMAN DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920935004",
            "telephone_number": "858-822-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "STACEY",
        "middle_name": "HYUN JOO",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-20",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carie Ann Montesa, NP
• Lori P Montross Thomas, PHD
• Oscar Monzon
• Minjung Jane Moon, MD
• Scott D. Moon, P.A.-C.
• Berna B Moore, PA-C
• Rebecca Moore, PH.D.
• Thomas R Moore, MD
• Nosheen Moosvi
• Jacquelyn Morales, MD

• Dentist in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.