Healthcare Provider Details

I. General information

NPI: 1649197922
Provider Name (Legal Business Name): MINJOO KI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

IV. Provider business mailing address

222 N 22ND ST APT 218
LINCOLN NE
68503-3615
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1330
  • Fax:
Mailing address:
  • Phone: 925-393-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: