Individual
TSWJFWM VANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3930 NORTHWOODS DR, ARDEN HILLS, MN 55112-6963
(651) 523-8584
(651) 523-8584
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
(651) 523-8500
(651) 523-8584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66014
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2016
Last updated
08/16/2019
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