Provider Demographics
NPI:1952510521
Name:SAMNANVETH, KIMKHAM
Entity Type:Individual
Prefix:
First Name:KIMKHAM
Middle Name:
Last Name:SAMNANVETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 WHISPERING OAKS ALCOVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8512
Mailing Address - Country:US
Mailing Address - Phone:952-496-2580
Mailing Address - Fax:
Practice Address - Street 1:8837 WHISPERING OAKS ALCOVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8512
Practice Address - Country:US
Practice Address - Phone:952-496-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant