Healthcare Provider Details

I. General information

NPI: 1801732193
Provider Name (Legal Business Name): Y NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BETHEL DR
SAINT PAUL MN
55112-6902
US

IV. Provider business mailing address

6438 84TH CT N
BROOKLYN PARK MN
55445-2272
US

V. Phone/Fax

Practice location:
  • Phone: 651-638-6400
  • Fax:
Mailing address:
  • Phone: 763-957-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: