Kazi Shafiul Moula, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

104602 Issued in CA

Practice address

Western Dental/ Brident 150Bfo
3077 W Shaw Ave
Fresno, CA 93711

Phone

(559) 490-1327

NPI assigned

Dec 16, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1104464684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 E NEES AVE APT 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937206014",
            "telephone_number": "267-444-8827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WESTERN DENTAL/ BRIDENT 150BFO",
            "address_2": "3077 W SHAW AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93711",
            "telephone_number": "559-490-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULA",
        "first_name": "KAZI",
        "middle_name": "SHAFIUL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "104602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vang Leng Mouanoutoua, PH.D.
• Blea Tou Mouavangsou
• Elizabeth Choua Mouavangsou, LMFT
• Kao Ying Mouavangsou, R.D.
• Pangchee Myer Mouavangsou, AMFT
• Courtney Moultrie, FNP
• Daniel Moultrie
• Lyndon Patrick Moultrie Jr.
• Rayana Mounlaphasith
• Molly Elizabeth Mounsey

• Dentist in Fresno, CA
• Providers in Fresno, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.