Healthcare Provider Details

I. General information

NPI: 1790648665
Provider Name (Legal Business Name): MISS KAO XIONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAO VANG

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-967-7977
  • Fax: 651-254-7990
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13647
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: