Healthcare Provider Details

I. General information

NPI: 1649117052
Provider Name (Legal Business Name): MAIDA KASIM MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 302A
NEW HOPE MN
55427-1241
US

IV. Provider business mailing address

4124 QUEBEC AVE N STE 302A
NEW HOPE MN
55427-1241
US

V. Phone/Fax

Practice location:
  • Phone: 952-201-1479
  • Fax: 952-800-0130
Mailing address:
  • Phone: 952-201-1479
  • Fax: 952-800-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: