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General NPI Number Information
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NPI Number | 1639802135
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Entity Type | Individual
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Provider Name | KENG MOUA PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/03/2022
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 615 LILLY RD NE STE 100
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City | OLYMPIA
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State | WA
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Zip | 98506-5117
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Country | US
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Telephone | 360-491-4211
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Fax | 360-493-0407
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | OLYMPIA
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State | WA
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Zip | 98507-0368
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Country | US
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Telephone | 360-491-8439
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Fax | 360-491-6328
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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