Provider Demographics
NPI:1679729446
Name:LOU, JEFFREY CHENG KOON (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHENG KOON
Last Name:LOU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9101 STONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1979
Mailing Address - Country:US
Mailing Address - Phone:804-330-9105
Mailing Address - Fax:
Practice Address - Street 1:8720 STONY POINT PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1988
Practice Address - Country:US
Practice Address - Phone:804-323-0226
Practice Address - Fax:804-323-0229
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101244166208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679729446Medicaid
VA1679729446Medicaid
VA018702U87Medicare PIN