Healthcare Provider Details

I. General information

NPI: 1407478969
Provider Name (Legal Business Name): CHRISTINA NGUYEN YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA KATHY NGUYEN OD

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 BUNKER LAKE BLVD NW
ANDOVER MN
55304-4010
US

IV. Provider business mailing address

1851 BUNKER LAKE BLVD NW
ANDOVER MN
55304-4010
US

V. Phone/Fax

Practice location:
  • Phone: 763-354-5717
  • Fax:
Mailing address:
  • Phone: 763-354-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011411
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: