Kenneth Taeho Moon, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0057219 Issued in MD

Practice address

24435 Mervell Dean Rd
Hollywood, MD 20636-2712

Phone

(301) 373-2116

NPI assigned

Oct 11, 2005

Last updated

Oct 24, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment NPD
• MGMC, LLC

  • General Practice Physician
  • Washington, DC
  • NPI 1891797148
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  DC

  Medicare reassignment NPD
• Medstar Medical Group II LLC

  • General Practice Physician
  • White Plains, MD
  • NPI 1407559081
  NPD
• Youngsik Moon, M.D., P.a.

  dba Hollywood Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Hollywood, MD
  • NPI 1831203215
  NPD (past)

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1972591345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "HOLLYWOOD",
            "state": "MD",
            "postal_code": "206360037",
            "telephone_number": "301-373-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24435 MERVELL DEAN RD",
            "city": "HOLLYWOOD",
            "state": "MD",
            "postal_code": "206362712",
            "telephone_number": "301-373-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "KENNETH",
        "middle_name": "TAEHO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DC",
            "license": "32929",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0057219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medstar Medical Group - Southern Maryland LLC (MedStar Shah Medical Group, LLC)
• Medstar Medical Group II LLC
• Kiran Mehta
• Michelle Menear
• Suzanne Moebius, PHARMD
• Betty Louise Moore, P.T.
• Mark Mozingo
• Aveek Mukherjee, MD
• National Rehabiliation Hospital, Inc (MedStar Health Physical Therapy at Hollywood)
• National Rehabiliation Hospital, Inc (Medstar Health Physical Therapy at Hollywood)

• Family Medicine Physician in Hollywood, MD
• Providers in Hollywood, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.