Provider Demographics
NPI:1548999865
Name:MOUACHEUPAO, LINDA ZONG (DCM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ZONG
Last Name:MOUACHEUPAO
Suffix:
Gender:F
Credentials:DCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SUMMIT DR N APT 313
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-5100
Mailing Address - Country:US
Mailing Address - Phone:347-433-3611
Mailing Address - Fax:
Practice Address - Street 1:4748 CHICAGO AVE STE 21
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4320
Practice Address - Country:US
Practice Address - Phone:612-361-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2018171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist