MEDICARE: SEBASTIAN ZOOTHAJ VANG

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	106S00000X	Behavior Technician		MN

General Provider Information

NPI Number	:	1760340517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEBASTIAN ZOOTHAJ VANG

Provider Business Mailing Address
First Line	:	2287 12TH AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55109-2410
Country	:	US
Telephone Number	:	763-360-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4255 LEXINGTON AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-6164
Country	:	US
Telephone Number	:	952-746-5350
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ SEBASTIAN ZOOTHAJ VANG ” Practice Location

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