Provider Demographics
NPI:1174058697
Name:SOUNG, PAY
Entity type:Individual
Prefix:
First Name:PAY
Middle Name:
Last Name:SOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 ASPEN CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1003
Mailing Address - Country:US
Mailing Address - Phone:651-398-1728
Mailing Address - Fax:651-436-2349
Practice Address - Street 1:848 ASPEN CIR
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55109-1003
Practice Address - Country:US
Practice Address - Phone:651-398-1728
Practice Address - Fax:651-436-2349
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA741158800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN562366725OtherHOME HEALTH CARE AGENCY