Healthcare Provider Details

I. General information

NPI: 1194655233
Provider Name (Legal Business Name): ABUBAKAR YASSIN ABDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 W 78TH STREET CIR STE 200
BLOOMINGTON MN
55435-5419
US

IV. Provider business mailing address

4470 W 78TH STREET CIR STE 200
BLOOMINGTON MN
55435-5419
US

V. Phone/Fax

Practice location:
  • Phone: 612-458-5083
  • Fax: 612-354-8387
Mailing address:
  • Phone: 612-458-5083
  • Fax: 612-354-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: