Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

DAVID SUNG-WOOK MOON M.D.
NPI 1164866414
Psychiatry & Neurology - Neurology with Special Qualifications in Child Neurology in Grand Rapids, MI

Q: What is David Moon's NPI number?

The NPI number for David Moon is 1164866414. It was assigned to this individual provider in the NPPES registry on April 17, 2013.

Q: What is David Moon's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology with Special Qualifications in Child Neurology, with taxonomy code 2084N0402X.

Q: When was this NPI record last updated?

The NPPES record for David Moon was last updated on July 17, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 17, 2013PECOS Enrolled

25 MICHIGAN ST NE STE 2100, GRAND RAPIDS, MI 49503(616) 267-2500 Get Directions Write a Review

NPPES record last updated: July 17, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 17, 2026, Feb 18, 2021, Oct 29, 2019 and 3 more (6 updates tracked since 2018).

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About David Sung-wook Moon M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAVID SUNG-WOOK MOON M.D. (NPI 1164866414) is an individual neurology with special qualifications in child neurology provider in Grand Rapids, Michigan, licensed in Michigan (4301114519) and active in the NPI registry since April 2013. He is enrolled in Medicare PECOS and maintains a secondary practice location in Traverse City.

NPPES Registry Identity

NPI1164866414

Entity TypeIndividualMale

Primary Taxonomy2084N0402X

Provider Legal NameDAVID SUNG-WOOK MOONCredential: M.D.

Location Address25 MICHIGAN ST NE STE 2100Grand Rapids, MI 49503-2526

Mailing Address100 Michigan St Ne # Mc845Grand Rapids, MI 49503-2560

Phone(616) 267-2500

Sole ProprietorNo

Enumeration DateApril 17, 2013

Last NPPES UpdateJuly 17, 20266 updates tracked since enumeration

NPPES CertifiedJuly 17, 2026

✔ NPI 1164866414 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · Neurology with Special Qualifications in Child NeurologyAllopathic & Osteopathic Physicians

Taxonomy Code2084N0402X

License✔ Licensed in MI · 4301114519

Definition

A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.

25 MICHIGAN ST NE STE 2100, Grand Rapids, MI 49503

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Secondary Practice Location 1

Location 11105 Sixth St, EKG ReadTraverse City, MI 49684 · Phone (231) 935-6239 · Fax (231) 935-7251

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

David Sung-wook Moon M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49503 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$126.15 typical visit price

range $54.34 – $166.68

Typical copayment $31.53 (range $13.58 – $41.67)

Most-billed visit code 99204

Established Patient

$96.44 typical visit price

range $17.09 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CALEB THIEL M.D.

Internal Medicine