Active NPI
Phinsaykeo Souriyathay
- Assisted Living Facility
- Brooklyn Park, MN
National Provider Identifier
1265079404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- Practice address
- 9300 Penn Ave N
Brooklyn Park, MN 55444-1166 - Phone
- (612) 368-1236
- NPI assigned
- Dec 6, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | Primary |
Addresses
Primary practice location
9300 Penn Ave N
Brooklyn Park, MN 55444-1166
Mailing address
6231 Sunny LN
Brooklyn Park, MN 55428-2732
Phone (612) 368-1236
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D1245705 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575590400000",
"number": "1265079404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6231 SUNNY LN",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554282732",
"telephone_number": "612-368-1236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 PENN AVE N",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554441166",
"telephone_number": "612-368-1236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOURIYATHAY",
"first_name": "PHINSAYKEO",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-06",
"last_updated": "2019-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D1245705",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.