Provider Demographics
NPI:1295352698
Name:VANG, TONG (OWNER)
Entity type:Individual
Prefix:
First Name:TONG
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3004
Mailing Address - Country:US
Mailing Address - Phone:651-890-2529
Mailing Address - Fax:651-890-2529
Practice Address - Street 1:1164 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3004
Practice Address - Country:US
Practice Address - Phone:651-890-2529
Practice Address - Fax:651-890-2529
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator