SOON MOON DO
NPI 1902367188
Surgery in Kingsport, TN

Q: What is Soon Moon's NPI number?

The NPI number for Soon Moon is 1902367188. It was assigned to this individual provider in the NPPES registry on March 28, 2019.

Q: What is Soon Moon's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Soon Moon was last updated on January 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 28, 2019PECOS EnrolledAccepts Medicare Assignment

130 W RAVINE RD STE 3A, KINGSPORT, TN 37660(423) 245-6101(423) 245-2396 Get Directions Write a Review

NPPES record last updated: January 29, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Soon Moon Do NPPES

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

SOON MOON DO (NPI 1902367188) is an individual surgery provider in Kingsport, Tennessee, licensed in Tennessee (6474) and active in the NPI registry since March 2019. She is enrolled in Medicare PECOS, is affiliated with Wellmont Holston Valley Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1902367188

Entity TypeIndividualFemale

Primary Taxonomy208600000X

Provider Legal NameSOON MOONCredential: DO

Location Address130 W RAVINE RD STE 3AKingsport, TN 37660-3841

Mailing Address1021 W Oakland Ave Ste 310Johnson City, TN 37604-2192 · (423) 952-2111

Phone(423) 245-6101

Fax(423) 245-2396

Sole ProprietorYes

Medical School CMSOtherGraduated 2019

Enumeration DateMarch 28, 2019

Last NPPES UpdateJanuary 29, 2026

NPPES CertifiedJanuary 29, 2026

✔ NPI 1902367188 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in TN · 6474

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

130 W RAVINE RD STE 3A, Kingsport, TN 37660

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Secondary Practice Locations 2

Location 1111 W Stone Dr Ste 310Kingsport, TN 37660-6030 · Phone (423) 398-7020

Location 220000 Harvard RoadWarrensville Heights, OH 44122 · Phone (216) 491-6000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Community Health Choice, Molina Healthcare, WellPoint.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Soon Moon Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9830432426

PECOS Enrollment IDI20241113001846, I20251018000443

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.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Wellmont Holston Valley Medical Center

Acute Care Hospitals · Kingsport, TN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number440017

Location130 West Ravine RoadKingsport, TN 37662 · Sullivan County

Emergency services

Houston Methodist Hospital

Acute Care Hospitals · Houston, TX

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number450358

Location6565 FanninHouston, TX 77030 · Harris County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37660 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

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

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

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Other Providers at the Same Location NPPES 14

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

MR. CHARLES DAVID BRAY FNP-BC

Nurse Practitioner (Family)