Individual
MISS PHINSAYKEO SOURIYATHAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9300 PENN AVE N, BROOKLYN PARK, MN 55444-1166
(612) 368-1236
Mailing address
6231 SUNNY LN, BROOKLYN PARK, MN 55428-2732
(612) 368-1236
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D1245705
—
CA
Enumeration date
12/06/2019
Last updated
12/06/2019
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