Healthcare Provider Details

I. General information

NPI: 1124098892
Provider Name (Legal Business Name): YAN FANG HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 RIDGEDALE DR
MINNETONKA MN
55305-1809
US

IV. Provider business mailing address

4205 SHOREWOOD TRL
MEDINA MN
55340-9376
US

V. Phone/Fax

Practice location:
  • Phone: 952-542-8250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 168350-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: