Healthcare Provider Details

I. General information

NPI: 1588588693
Provider Name (Legal Business Name): VILIAM M ZONG VANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 CLUB WEST PKWY STE 190
BLAINE MN
55449-3673
US

IV. Provider business mailing address

10950 CLUB WEST PKWY STE 190
BLAINE MN
55449-3673
US

V. Phone/Fax

Practice location:
  • Phone: 763-400-4940
  • Fax:
Mailing address:
  • Phone: 763-400-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7451
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: