Provider Demographics
NPI:1811299928
Name:MOUA, MICHAEL CHAY (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHAY
Last Name:MOUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHAY
Other - Middle Name:
Other - Last Name:MOUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7275 E SOUTHGATE DR
Mailing Address - Street 2:SUITE 204 - 206
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2628
Mailing Address - Country:US
Mailing Address - Phone:916-428-3788
Mailing Address - Fax:916-428-0788
Practice Address - Street 1:7275 E SOUTHGATE DR
Practice Address - Street 2:SUITE 204 - 206
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2628
Practice Address - Country:US
Practice Address - Phone:916-428-3788
Practice Address - Fax:916-428-0788
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17667207Q00000X
CAA128268207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine