Provider Demographics
NPI:1053614263
Name:MOON, BAHN YAH (DDS)
Entity type:Individual
Prefix:DR
First Name:BAHN YAH
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PARK AVE
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8015
Mailing Address - Country:US
Mailing Address - Phone:212-758-0040
Mailing Address - Fax:
Practice Address - Street 1:530 PARK AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8015
Practice Address - Country:US
Practice Address - Phone:212-758-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics