Provider Demographics
NPI:1184623290
Name:CHOU, JEFFREY VINCENT (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:VINCENT
Last Name:CHOU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3937
Practice Address - Country:US
Practice Address - Phone:502-895-3840
Practice Address - Fax:502-897-3642
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00193213E00000X, 213ES0103X
KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001936Medicaid
KY80900053Medicaid
KY1184623290OtherNPI
KY90008228Medicaid
KY80900053Medicaid
KYU27382Medicare UPIN
KY1184623290OtherNPI