Provider Demographics
NPI:1770268468
Name:GIANG, VICKI MY (PA-C)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:MY
Last Name:GIANG
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2145
Mailing Address - Country:US
Mailing Address - Phone:952-994-1367
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 130N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1096
Practice Address - Country:US
Practice Address - Phone:651-447-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant