Healthcare Provider Details

I. General information

NPI: 1811299928
Provider Name (Legal Business Name): MICHAEL CHAY MOUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHAY MOUA M.D.

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 E SOUTHGATE DR SUITE 204 - 206
SACRAMENTO CA
95823-2628
US

IV. Provider business mailing address

7275 E SOUTHGATE DR SUITE 204 - 206
SACRAMENTO CA
95823-2628
US

V. Phone/Fax

Practice location:
  • Phone: 916-428-3788
  • Fax: 916-428-0788
Mailing address:
  • Phone: 916-428-3788
  • Fax: 916-428-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA 17667
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA128268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: