Provider Demographics
NPI:1124784871
Name:VANG, MAI H
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:H
Last Name:VANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 NORTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4769
Mailing Address - Country:US
Mailing Address - Phone:952-529-0869
Mailing Address - Fax:
Practice Address - Street 1:1164 NORTON ST APT 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4769
Practice Address - Country:US
Practice Address - Phone:952-529-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health