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KENNETH TAEHO MOON M.D.
NPI 1972591345
Family Medicine in Hollywood, MD

Active since October 11, 2005PECOS Enrolled
24435 MERVELL DEAN RD, HOLLYWOOD, MD 20636(301) 373-2116 Get Directions Write a Review

NPPES record last updated: October 24, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kenneth Taeho Moon M.d. NPPES

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

KENNETH TAEHO MOON M.D. (NPI 1972591345) is an individual family medicine provider in Hollywood, Maryland, licensed in Maryland (D0057219) and active in the NPI registry since October 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1972591345
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameKENNETH TAEHO MOONCredential: M.D.
Location Address24435 MERVELL DEAN RDHollywood, MD 20636-2712
Mailing AddressPo Box 37Hollywood, MD 20636-0037 · (301) 373-2116
Phone(301) 373-2116
Sole ProprietorNo
Enumeration DateOctober 11, 2005
Last NPPES UpdateOctober 24, 2025
NPPES CertifiedOctober 24, 2025
✔ NPI 1972591345 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in MD · D0057219✔ Licensed in DC · 32929
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
24435 MERVELL DEAN RD, Hollywood, MD 20636
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Other Identifiers 1

Other080185963DC · Medicare Rr

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth Taeho 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 20636 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
$89.75 typical visit price
range $57.99 – $175.57
Typical copayment $22.43 (range $14.49 – $43.89)
Most-billed visit code 99203
Established Patient
$102.11 typical visit price
range $18.66 – $143.02
Typical copayment $25.52 (range $4.66 – $35.75)
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 3

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

YOUNGSIK MOON, M.D., P.A.
Family Medicine
24435 MERVELL DEAN RD
HOLLYWOOD, MD 20636
St. Mary's County (301) 373-2116
LAURA ZILBERMAN NP-C
Nurse Practitioner (Family)
24435 MERVELL DEAN RD
HOLLYWOOD, MD 20636
St. Mary's County (301) 373-2116
YOUNGSIK MOON, M.D., P.A.
Clinic/Center (Ambulatory Surgical)
24435 MERVELL DEAN RD
HOLLYWOOD, MD 20636
St. Mary's County (301) 373-2116

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Moon's NPI number?

The NPI number for Kenneth Moon is 1972591345. It was assigned to this individual provider in the NPPES registry on October 11, 2005.

Where is Kenneth Moon located?

Kenneth Moon practices at 24435 Mervell Dean Rd, Hollywood, MD 20636. The listed phone number is (301) 373-2116.

What is Kenneth Moon's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Kenneth Moon enrolled in Medicare?

Yes. Kenneth Moon is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kenneth Moon was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.