Thek Mouanoutoua, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

20176 Issued in CA

Practice address

4929 E Kings Canyon Rd
Fresno, CA 93727-3812

Phone

(559) 255-6476

NPI assigned

Feb 19, 2009

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greater Fresno Health Organization, Inc.

  • Exclusive Provider Organization
  • Fresno, CA
  • NPI 1265521488
  Medicare reassignment

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1275772964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4929 E. KINGS CANYON ROAD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273812",
            "telephone_number": "559-255-6476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4929 E KINGS CANYON RD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273812",
            "telephone_number": "559-255-6476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUANOUTOUA",
        "first_name": "THEK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-19",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "20176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaiah Mouanoutoua, RPH
• Losthongsanh Mouanoutoua, OTR/L
• Megan Cuanaag Mouanoutoua
• Mouachu Mouanoutoua
• Mouatou Mouanoutoua, MD
• Vang Leng Mouanoutoua, PH.D.
• Blea Tou Mouavangsou
• Elizabeth Choua Mouavangsou, LMFT
• Kao Ying Mouavangsou, R.D.
• Pangchee Myer Mouavangsou, AMFT

• Physician Assistant in Fresno, CA
• Providers in Fresno, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.