MEDICARE: MRS. KAYING VANG MIDWAYHOMEHEALTHCARE

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	175L00000X	Homeopath	931420200	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750461042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYING VANG MIDWAYHOMEHEALTHCARE

Provider Business Mailing Address
First Line	:	1072 PAYNE AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3434
Country	:	US
Telephone Number	:	651-793-6901
Fax Number	:	651-776-5251

Provider Business Practice Location Address
First Line	:	1324 PAYNE AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3434
Country	:	US
Telephone Number	:	651-793-6901
Fax Number	:	651-776-5251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/24/2014

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