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NPI Code Detail

MEDICARE: KENG MOUA PA-C

MEDICARE: KENG MOUA PA-C
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
1363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639802135
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENG MOUA PA-C
Provider Business Mailing Address
First Line : PO BOX 368
Second Line :
City : OLYMPIA
State : WA
Zip : 98507-0368
Country : US
Telephone Number : 360-491-8439
Fax Number : 360-491-6328
Provider Business Practice Location Address
First Line : 615 LILLY RD NE STE 100
Second Line :
City : OLYMPIA
State : WA
Zip : 98506-5117
Country : US
Telephone Number : 360-491-4211
Fax Number : 360-493-0407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2022
Last Update Date : 06/11/2026

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Directions to “ KENG MOUA PA-C” Practice Location

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