Healthcare Provider Details

I. General information

NPI: 1760321152
Provider Name (Legal Business Name): AWCUVIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 TYLER ST NE
BLAINE MN
55434-2954
US

IV. Provider business mailing address

11420 TYLER ST NE
BLAINE MN
55434-2954
US

V. Phone/Fax

Practice location:
  • Phone: 763-200-1303
  • Fax:
Mailing address:
  • Phone: 763-200-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. TONG VANG
Title or Position: CEO
Credential:
Phone: 763-200-1303