Individual
KENG MOUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
615 LILLY RD NE STE 100, OLYMPIA, WA 98506-5117
(360) 491-4211
(360) 493-0407
Mailing address
PO BOX 368, OLYMPIA, WA 98507-0368
(360) 491-8439
(360) 491-6328
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2289590
—
WA
Enumeration date
07/03/2022
Last updated
05/30/2025
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