Healthcare Provider Details

I. General information

NPI: 1225805351
Provider Name (Legal Business Name): ZENA V KOCHER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CHICAGO AVE STE 101
MINNEAPOLIS MN
55407-1353
US

IV. Provider business mailing address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-4822
  • Fax: 612-333-3108
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1217
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: