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NPI Code Detail

MEDICARE: MYSOON AYUOB

MEDICARE: MYSOON AYUOB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician108617MN
2207Q00000XFamily Medicine Physician4301104105NY
3207Q00000XFamily Medicine Physician60020MN

General Provider Information

NPI Number : 1003251885
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYSOON AYUOB
Provider Business Mailing Address
First Line : 3850 PARK NICOLLET BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-2527
Country : US
Telephone Number : 952-883-1000
Fax Number :
Provider Business Practice Location Address
First Line : 300 STATE AVE
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-6319
Country : US
Telephone Number : 150-733-3330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2013
Last Update Date : 02/16/2021

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Directions to “ MYSOON AYUOB ” Practice Location

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