Healthcare Provider Details

I. General information

NPI: 1598995862
Provider Name (Legal Business Name): MR. KOU TOU XIONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7732 HAMPSHIRE AVE N
BROOKLYN PARK MN
55445-2707
US

IV. Provider business mailing address

7732 HAMPSHIRE AVE N
BROOKLYN PARK MN
55445-2707
US

V. Phone/Fax

Practice location:
  • Phone: 763-300-4614
  • Fax: 763-560-1850
Mailing address:
  • Phone: 763-300-4614
  • Fax: 763-560-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: