Provider Demographics
NPI:1609095819
Name:VANG, KOU (DC)
Entity Type:Individual
Prefix:
First Name:KOU
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-3841
Mailing Address - Country:US
Mailing Address - Phone:651-774-2020
Mailing Address - Fax:651-774-2524
Practice Address - Street 1:1030 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-3841
Practice Address - Country:US
Practice Address - Phone:651-774-2020
Practice Address - Fax:651-774-2524
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor