Healthcare Provider Details

I. General information

NPI: 1104018068
Provider Name (Legal Business Name): BOBBEE BEE VANG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEE VANG L.AC.

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST MAIL ROUTE 15115
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

800 E 28TH ST MAIL ROUTE 15115
MINNEAPOLIS MN
55407-3723
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-1931
  • Fax: 612-863-9019
Mailing address:
  • Phone: 612-863-1931
  • Fax: 612-863-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1310
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: