Provider Demographics
NPI:1437588670
Name:NYANG, MAGN
Entity type:Individual
Prefix:
First Name:MAGN
Middle Name:
Last Name:NYANG
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MAGN
Other - Middle Name:OCHALLA
Other - Last Name:NYANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:542 82ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1907
Mailing Address - Country:US
Mailing Address - Phone:612-636-8926
Mailing Address - Fax:
Practice Address - Street 1:542 82ND AVE NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1907
Practice Address - Country:US
Practice Address - Phone:612-636-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional