Provider Demographics
NPI:1336598812
Name:MIRONOVA-CHIN, YELENA SERGEEVNA (MD)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:SERGEEVNA
Last Name:MIRONOVA-CHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:SERGEEVNA
Other - Last Name:MIRONOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6741
Practice Address - Country:US
Practice Address - Phone:952-993-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI691362084P0800X
WI13365988122084P0800X
MN667532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry