Provider Demographics
NPI:1770801896
Name:GOGGIN, GRACE JIANG (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:JIANG
Last Name:GOGGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:JIANG-GOGGIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:612-262-4258
Practice Address - Street 1:255 NORTH SMITH AVE SUITE 100
Practice Address - Street 2:UNITED MEDICAL SPECIALTIES-JOHN NASSEFF MEDICAL CENTER
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2518
Practice Address - Country:US
Practice Address - Phone:651-241-5000
Practice Address - Fax:651-241-7678
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110014447Medicare PIN