Individual provider Active NPI

Mai Z Vang

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1063197697
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1544 Timberlake Rd
Saint Paul, MN 55117-3946
Phone
(651) 602-7500
NPI assigned
Jun 20, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X MN Primary

Addresses

Primary practice location

1544 Timberlake Rd
Saint Paul, MN 55117-3946

Mailing address

20760 Xavis St NW
Oak Grove, MN 55011-9277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250820000193 MN Practitioner - Physician Assistant 9133628704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Side Community Health Services, Inc. 51 clinicians

Practice addresses (Care Compare)

153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500

1544 Timberlake Rd
Saint Paul, MN 55117-3946
Phone (651) 602-7500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
West Side Community Health Services, Inc. CurrentSince Sep 22, 2025 Accepting new patients
West Side Community Health Services, Inc. CurrentSince Sep 22, 2025 Accepting new patients

Locations

1544 Timberlake Rd
Saint Paul, MN 55117
Phone (651) 558-2191

153 Cesar Chavez St
West Saint Paul, MN 55107
Phone (651) 222-1816

Interoperability endpoints

  • Direct secure messaging: mvang832913@direct.ochin.org

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1063197697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20760 XAVIS ST NW",
            "city": "OAK GROVE",
            "state": "MN",
            "postal_code": "550119277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1544 TIMBERLAKE RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551173946",
            "telephone_number": "651-602-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANG",
        "first_name": "MAI",
        "middle_name": "Z",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.