Provider Demographics
NPI:1457099764
Name:MOUA, PANG TAO (PHD)
Entity type:Individual
Prefix:MISS
First Name:PANG
Middle Name:TAO
Last Name:MOUA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ARKANSAS ST APT 162
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3943
Mailing Address - Country:US
Mailing Address - Phone:952-652-7064
Mailing Address - Fax:
Practice Address - Street 1:210 ARKANSAS ST APT 162
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3943
Practice Address - Country:US
Practice Address - Phone:952-652-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT712870235Z00000X
CA35025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist