Individual provider Active NPI

Muaj Lo, MD

  • Family Medicine Physician
  • Fort Bragg, CA
National Provider Identifier
1487644985
Registry record updated Feb 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C206263 Issued in CA
Practice address
205 South St
Fort Bragg, CA 95437-5540
Phone
(707) 964-1251
Fax
(707) 961-2722
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C206263 CA Primary
Family Medicine Physician 207Q00000X 54717 MN
Family Medicine Physician 207Q00000X 47517 WI

Addresses

Primary practice location

205 South St
Fort Bragg, CA 95437-5540

Mailing address

205 South St
Fort Bragg, CA 95437-5540
Phone (707) 964-1251

Other identifiers 1

IdentifierTypeStateIssuer
34607100MedicaidWI

Other names 1

  • Moua Vang Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121022000596 MN Practitioner - Family Practice 8921051277 Reassigns benefits to 2 organizations
I20260615003622 CA Practitioner - Family Practice 8921051277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Side Community Health Services, Inc.Group PAC ID 2062306434, shared by 16 NPIs, 51 clinicians
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500

1544 Timberlake Rd
Saint Paul, MN 55117-3946
Phone (651) 602-7500

8325 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5868

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5300

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

895 7TH St E
Saint Paul, MN 55106-3871
Phone (651) 602-7500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C206263CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. Current Accepting new patients
West Side Community Health Services, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Jan 14, 2013 Accepting new patients
West Side Community Health Services, Inc. CurrentSince Aug 8, 2012 Accepting new patients
West Side Community Health Services, Inc. CurrentSince Aug 8, 2012 Accepting new patients
Group Health Plan, Inc. CurrentSince Jan 14, 2013 Accepting new patients
Mendocino Coast Clinics Inc Past Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

1544 Timberlake Rd
Saint Paul, MN 55117
Phone (651) 558-2191

153 Cesar Chavez St
West Saint Paul, MN 55107
Phone (651) 222-1816

Interoperability endpoints

  • Direct secure messaging: mlo733115@direct.ochin.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1487644985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SOUTH ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375540",
            "telephone_number": "707-964-1251",
            "fax_number": "707-961-2722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SOUTH ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375540",
            "telephone_number": "707-964-1251",
            "fax_number": "707-961-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LO",
        "first_name": "MUAJ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C206263",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "54717",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "47517",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34607100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOUA",
            "last_name": "VANG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Bragg, CA

Sources for this page

Verify at the official NPI Registry.