Healthcare Provider Details

I. General information

NPI: 1740171289
Provider Name (Legal Business Name): ASHRAF HUSSEIN MAALIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 4TH ST SW STE 108
WILLMAR MN
56201-3374
US

IV. Provider business mailing address

330 4TH ST SW STE 108
WILLMAR MN
56201-3374
US

V. Phone/Fax

Practice location:
  • Phone: 612-237-3840
  • Fax:
Mailing address:
  • Phone: 612-237-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: