| Doctor Name: | KHOUNKHAM KEOVILAJ |
| NPI Number: | 1013162742 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 23 Empire Dr Suite 123 Saint Paul, MN - 551031856 |
| Business Phone Number: | 6512222787 |
| Business Fax Number: | 6512241057 |
| Mailing Address: | 1124 7th Ave, WORTHINGTON |
| State: | MN |
| Postal Code: | 561872212 |
| Phone Number: | 5073725670 |
| Fax Number: | 6512241057 |
| NPI Enumeration Date: | 11/21/2008 |
| NPI Last Update Date: | 11/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3747P1801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Technician |
| Taxonomy Specialization: | Personal Care Attendant |
| Taxonomy Definition: | An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |