Provider Demographics
NPI:1114303831
Name:KANG, MINDY LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LEE
Last Name:KANG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VILLAGE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7092
Mailing Address - Country:US
Mailing Address - Phone:678-219-8583
Mailing Address - Fax:651-800-9859
Practice Address - Street 1:200 VILLAGE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7092
Practice Address - Country:US
Practice Address - Phone:651-219-8583
Practice Address - Fax:651-800-9859
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210035363LF0000X
MN5147363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care