Provider Demographics
NPI:1386078491
Name:JEFFREY V. CHOU, DPM
Entity type:Organization
Organization Name:JEFFREY V. CHOU, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:270-433-5806
Mailing Address - Street 1:PO BOX 43102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0102
Mailing Address - Country:US
Mailing Address - Phone:270-433-5806
Mailing Address - Fax:270-433-2443
Practice Address - Street 1:117 S HUBBARDS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3900
Practice Address - Country:US
Practice Address - Phone:502-895-3840
Practice Address - Fax:502-897-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00193332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001936Medicaid
KY80001936Medicaid