Fan Mou, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

052212 Issued in NY

Practice address

128 Mott St
Suite 203
New York, NY 10013-5540

Phone

(212) 965-8113

Fax

(212) 965-8114

NPI assigned

Jan 15, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497806582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 RIVERSIDE DR",
            "address_2": "APT #5G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100273202",
            "telephone_number": "917-526-2946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MOTT ST",
            "address_2": "SUITE 203",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100135540",
            "telephone_number": "212-965-8113",
            "fax_number": "212-965-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOU",
        "first_name": "FAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02743382",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abby Elizabeth Motycka
• Andrew R Motzer, MD
• Rachel Sara Motzer
• Robert J Motzer, MD
• Chuan Jing Mou
• Jingyi Mou
• Bruna Moubarak
• Michelle Mireille Moufawad
• Saeed Mougharbel
• Vivian Mougios, PHD

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.