Provider Demographics
NPI:1639808991
Name:MOUA, YUE PHENG
Entity Type:Individual
Prefix:
First Name:YUE PHENG
Middle Name:
Last Name:MOUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 LLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4723
Mailing Address - Country:US
Mailing Address - Phone:715-590-3182
Mailing Address - Fax:
Practice Address - Street 1:1605 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4723
Practice Address - Country:US
Practice Address - Phone:715-590-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)