MEDICARE: SEJONG ACADEMY OF MINNESOTA

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
1	251300000X	Local Education Agency (LEA)		MN

General Provider Information

NPI Number	:	1558769869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEJONG ACADEMY OF MINNESOTA

Provider Business Mailing Address
First Line	:	1330 BLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2007
Country	:	US
Telephone Number	:	651-330-6944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2007
Country	:	US
Telephone Number	:	651-330-6944
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRAD TIPKA
Credential	:
Telephone Number	:	651-330-6944

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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