Van Dyke Kofi Noah

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

1083493-1-HCBS Issued in MN

Practice address

4836 Safari Pass
Eagan, MN 55122-2663

Phone

(952) 846-8047

Fax

(651) 452-2698

NPI assigned

Nov 28, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1619410412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4836 SAFARI PASS",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222663",
            "telephone_number": "952-846-8047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4836 SAFARI PASS",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222663",
            "telephone_number": "952-846-8047",
            "fax_number": "651-452-2698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOAH",
        "first_name": "VAN DYKE",
        "middle_name": "KOFI",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MN",
            "license": "1083493-1-HCBS",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": "1083493-1-HCBS",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT FOSTER CARE",
            "identifier": "1081688-1-AFC",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Stephen Nies, MD
• Madison S Nightingale, LMT
• James Nissen
• Fadi Adnan Niyazi, M.D.
• Nkoyo Nyong-Bassey & Funmilayo Okoya LLC
• Cynthia Nobles, PHARM D
• Alana Chrisitie Noffsinger, M.A., LMFT
• Mary Anne Nolan, L.AC.
• Abdulkadir Abdiwahab Nor
• Ammy Norgren

• Behavior Technician in Eagan, MN
• Providers in Eagan, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.