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Mr. Song Jun Moon, PA-C
Military Health Care Provider in Lackland Afb, Texas
NPI 1780019539

Song Jun Moon is a Military Health Care Provider based in Lackland Afb, TX. Song Jun Moon practices in Lackland Afb, TX and has the professional credentials of PA-C. The NPI Number for Song Jun Moon is 1780019539 and holds a License No. (Texas).

The current practice location address for Song Jun Moon is 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX and can be reached out via phone at 210-292-1455.

Location: 1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX, 78236-5638
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1780019539
Provider Name
Song Jun Moon
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX, 78236-5638
Phone Number
210-292-1455
Fax Number
Provider Enumeration Date
09/12/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1100 Wilford Hall Loop Bldg 4554
City
Lackland Afb
State
Texas
Zip
78236-5638
Phone Number
210-292-1455
Fax Number
person
Provider Business Mailing Address Details
Address
1100 Wilford Hall Loop Bldg 4554
City
Lackland Afb
State
Texas
Zip
78236-5638
Phone Number
210-292-1455
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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