Healthcare Provider Details

I. General information

NPI: 1154502573
Provider Name (Legal Business Name): JOHN MOUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 N CHESTNUT AVE STE 101
FRESNO CA
93720-0359
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7270
  • Fax: 559-603-7271
Mailing address:
  • Phone:
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101940
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA101940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: