Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Song Jun Moon, PA-C

Individual provider Physician Assistant · NPI 1780019539

Mr. Song Jun Moon, PA-C is a Physician Assistant in Lackland AFB, Texas. Qualified in 2014, 12 years ago. Practices with Family Care Center LLC, a 693-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
12
Licensed in
TX
In the registry since
2013
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1100 Wilford Hall Loop Bldg 4554
Lackland AFB, TX 78236-5638
Phone: (210) 292-1455
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA18550 (TX)
Military Health Care Provider Taxonomy 171000000X

Record details

NPI number1780019539
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedSeptember 12, 2013
Last updated in NPPESDecember 17, 2024
Certification dateDecember 17, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Family Care Center Llc — 693 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Lackland AFB