Healthcare Provider Details

I. General information

NPI: 1780017020
Provider Name (Legal Business Name): YEEWAN SUM KAO ACNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FULTON ST SE
MINNEAPOLIS MN
55455-4800
US

IV. Provider business mailing address

909 FULTON ST SE
MINNEAPOLIS MN
55455-4800
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-7422
  • Fax: 612-676-8992
Mailing address:
  • Phone: 612-672-7422
  • Fax: 612-676-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0168
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: