Provider Demographics
NPI:1669678199
Name:TIMP, HUONG T (PA)
Entity Type:Individual
Prefix:MRS
First Name:HUONG
Middle Name:T
Last Name:TIMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:HUONG
Other - Middle Name:T
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C (MSPAS)
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:P4 RADIOLOGY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:P4 RADIOLOGY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MN1292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00604466Medicare PIN
ILK40448Medicare PIN