MR. SONG JUN MOON (NPI# 1780019539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780019539 |
| Entity Type | Individual |
| Full Name | MR. SONG JUN MOON |
| Credential | PA-C |
| Practice Address |
1100 Wilford Hall Loop Bldg 4554 Lackland Afb TX 78236-5638 |
| Mailing Address |
1100 Wilford Hall Loop Lackland Afb TX 78236-5638 |
| Practice Telephone | 2102921455 |
| Mailing Telephone | 2102921455 |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2020-11-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 301 Fisher St, 81st Mdg Family Health Clinic, Keesler Afb, MS 39534 | 2106437262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740308501 | Song Yong Moon | Physician Assistant | 500 Upper Chesapeake Dr, Bel Air, MD 21014-4324 | 2007-03-27 |
| Street Address |
1100 WILFORD HALL LOOP BLDG 4554 |
| City | LACKLAND AFB |
| State | TX |
| Zip Code | 78236-5638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457834277 | Michael Ryan Donohue | Physical Therapist | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-5638 | 2018-09-07 |
| 1992201446 | Michael Adrian Watson | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236 | 2018-04-03 |
| 1306348917 | Elias Z Tohme | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-5638 | 2018-02-28 |
| 1619359098 | Tracy Hoover | Audiologist | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236 | 2015-06-23 |
| 1780943035 | Caroline Alice Bolduc | Internal Medicine | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236 | 2012-05-07 |
| 1699064220 | Samuel Leathen Madson | General Practice | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-5638 | 2011-04-05 |
| 1962729939 | Jeffrey D Morgan | Emergency Medicine | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-5638 | 2010-04-29 |
| 1649594813 | Michael Hylton Edging | Nurse Practitioner | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-5638 | 2010-03-17 |
| 1386967982 | Charisma Bautista Evangelista | Ophthalmology | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236 | 2010-03-10 |
| 1619203429 | Amy Lynn | Nurse Practitioner | 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-7517 | 2009-10-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063047363 | Arnoldo Arturo Gonzalez Jr. | Specialist/Technologist | 1033 Truemper St, Lackland Afb, TX 78236 | 2020-03-06 |
| 1023643343 | Meredith Grace Cockerell | Specialist/Technologist | W Military Drive, San Antonio, TX 78236 | 2020-03-06 |
| 1578120598 | Hali Rashelle Hall | Dentist | 1615 Truemper St, Blg 6418, Attn: 59ds/sgdn, Jbsa Lackland, TX 78236 | 2019-05-24 |
| 1952967077 | Paul Fianza Boseman | Nurse Practitioner | 1106 Wilford Hall Loop, San Antonio, TX 78236 | 2019-05-14 |
| 1689161978 | Kelly Jones Buckshire | Dentist | Dunn Dental Clinic, 1615 Truemper Rd, San Antonio, TX 78236 | 2018-04-23 |
| 1902308570 | Roger Louis Farney | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg. 4554, Jbsa Lackland Afb, TX 78236 | 2018-02-28 |
| 1568916856 | Thomas Maxwell Woolf | Dentist | 1100 Wilford Hall Ambulatory Surgical Center, Lackland Afb, TX 78236 | 2016-08-04 |
| 1831544956 | Michael Veronneau | Student in an Organized Health Care Education/Training Program | 59 Mdw/ge 1100 Wilford Hall Loop, Bldg. 4554, Jbsa Lackland, TX 78236 | 2016-04-26 |
| 1376906958 | David Kephart Jr. | General Practice | 1100 Wilford Hall Loop Bldg 4454, Jbsa Lackland, TX 78236 | 2016-04-01 |
| 1184084089 | Olivia Arballo | Dermatology | Wilford Hall Asc, Attn: Dept of Dermatology, 1100 Wilford Hall Loop Bldg 4554, Jbsa-lackland, TX 78236 | 2016-03-04 |
| Find all providers in zip 78236 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235303140 | Danielle E Schnitker | Military Health Care Provider | 2200 Bergquist Dr, 59th Ors, Lackland Afb, TX 78236-9907 | 2008-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805454 | Tri Huynh Minh Nguyen | Military Health Care Provider | 7826 Enchanted Cliff Dr, El Paso, TX 79911-7508 | 2020-09-10 |
| 1700355237 | William Christopher Petty | Military Health Care Provider | 21227 Torch Street, Biggs Field, TX 79918 | 2018-11-14 |
| 1346629094 | Grada Berry | Military Health Care Provider | 2520 Heather Brook Ln Apt 804, Arlington, TX 76006-5177 | 2015-05-28 |
| 1215323514 | Kathleen Schurr | Military Health Care Provider | 47th Medical Group, Laughlin Afb, TX 78840 | 2015-04-13 |
| 1639518616 | Treble Clef Technologies | Military Health Care Provider | 3233 Tomahawk St, El Paso, TX 79936-2315 | 2013-06-23 |
| 1679837355 | Jeffrey Hoffmann | Military Health Care Provider | 1640 N Zaragoza Rd, Apt 118, El Paso, TX 79936-8004 | 2012-06-27 |
| 1194022566 | William Resto-rivera | Military Health Care Provider | J Street Bldg 3000, Federal Medical Center Carswell, Fort Worth, TX 76127-0066 | 2011-02-22 |
| 1437456373 | Jennifer Leigh Noblin | Military Health Care Provider | Sheppard Afb Mental Health Clinic, 149 Hart St. Bldg 1200, Wichita Falls, TX 76311 | 2011-02-11 |
| 1609179159 | Verisha Virginia Dixon | Military Health Care Provider | 81945 Fm 2252 Ste 115, Cheroke Medical Services, Garden Ridge, TX 78266 | 2010-12-06 |
| 1215190004 | Joni Patricia Gumban | Military Health Care Provider | 409 Greene St, Webster, TX 77598-6701 | 2008-07-02 |
| Find all providers with the same taxonomy | ||||
| City | LACKLAND AFB |
| Zip Code | 78236 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.