Provider Demographics
NPI:1083114300
Name:XIONG, SANOUK (DNP, NP-C FNP)
Entity Type:Individual
Prefix:DR
First Name:SANOUK
Middle Name:
Last Name:XIONG
Suffix:
Gender:M
Credentials:DNP, NP-C FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-4008
Mailing Address - Country:US
Mailing Address - Phone:763-742-9757
Mailing Address - Fax:
Practice Address - Street 1:4112 JOYCE LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-4008
Practice Address - Country:US
Practice Address - Phone:763-742-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5780363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF01180845OtherAMERICAN ACADEMY OF NURSE PRACTITONERS