Individual
THIRATH MARK LUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17210 KENYON AVE, LAKEVILLE, MN 55044-6903
(651) 968-5201
(651) 968-5903
Mailing address
710 COMMERCE DR STE 200, WOODBURY, MN 55125-4925
(651) 968-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10898
MN
Other
Enumeration date
10/27/2009
Last updated
10/31/2025
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