Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A101940 | CA |
Y | 2080P0214X | Pediatric Pulmonologist | A101940 | CA |
NPI | 1154502573 |
---|---|
Provider Name | John Moua |
First Address | Fresno, CA 93721-1431 |
Second Address | Clovis, CA 93611-6886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2007 |
Last Update Date | 29/11/2018 |