Provider Demographics
NPI:1235380569
Name:JOHNSON, JENNIFER YUN (LIC AC, MAOM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YUN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LIC AC, MAOM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:YUN
Other - Last Name:NOETZLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICAC, MAOM
Mailing Address - Street 1:4200 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5191
Mailing Address - Country:US
Mailing Address - Phone:952-345-1953
Mailing Address - Fax:
Practice Address - Street 1:4200 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5191
Practice Address - Country:US
Practice Address - Phone:952-345-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist