Provider Demographics
NPI:1871824789
Name:ORDNER, JON HWANG
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:HWANG
Last Name:ORDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FLYING CLOUD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3320
Mailing Address - Country:US
Mailing Address - Phone:763-370-8425
Mailing Address - Fax:
Practice Address - Street 1:6545 FLYING CLOUD DR STE 100
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3320
Practice Address - Country:US
Practice Address - Phone:763-370-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist