Healthcare Provider Details

I. General information

NPI: 1205795747
Provider Name (Legal Business Name): JUSTINE WAI-WAI HAUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 TOWN CENTRE DR STE 205
EAGAN MN
55123-1370
US

IV. Provider business mailing address

16715 STIRRUP LN
EDEN PRAIRIE MN
55347-3390
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1145
  • Fax: 612-870-5491
Mailing address:
  • Phone: 612-871-1145
  • Fax: 612-870-5491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15695
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: