Provider Demographics
NPI:1497022701
Name:KAOU, MOHAMED A (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:KAOU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 E TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5319
Mailing Address - Country:US
Mailing Address - Phone:559-577-7828
Mailing Address - Fax:
Practice Address - Street 1:5555 E KINGS CANYON RD
Practice Address - Street 2:SU101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4532
Practice Address - Country:US
Practice Address - Phone:559-255-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist