Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ji Soo Moon, AG-ACNP

Individual provider Acute Care Nurse Practitioner · NPI 1043804255

Ji Soo Moon, AG-ACNP is a Nurse Practitioner in Forest Hills, New York. Graduated from University of Massachusetts Medical School in 2020, 6 years ago. Works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts and New York.

Years since qualifying
6
Trained at
University of Massachusetts Medical School
Licensed in
MA, NY
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

10201 66th Rd
Forest Hills, NY 11375-2029
Phone: (718) 830-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 55 Lake Ave N, Worcester, MA 01655-0002 — (508) 334-1000

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence F432459-01 (NY)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence RN2324806 (MA)

Record details

NPI number1043804255
Entity typeIndividual (Type 1)
GenderFemale
Credentials AG-ACNP
Sole proprietorNo
NPI enumeratedFebruary 28, 2021
Last updated in NPPESJuly 13, 2023
Certification dateJuly 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolUNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Forest Hills