MEDICARE: DR. JOHN MOUA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A101940	CA
2	2080P0214X	Pediatric Pulmonology Physician	A101940	CA

General Provider Information

NPI Number	:	1154502573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MOUA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 889442
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90088-9442
Country	:	US
Telephone Number	:
Fax Number	:	559-443-2681

Provider Business Practice Location Address
First Line	:	7145 N CHESTNUT AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0359
Country	:	US
Telephone Number	:	559-603-7270
Fax Number	:	559-603-7271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	04/23/2026

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