Individual
JAY JIEKUEN LOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4625 CHURCHILL ST, SUITE 211, SHOREVIEW, MN 55126-5868
(651) 765-9800
(651) 765-9801
Mailing address
4625 CHURCHILL ST, SUITE 211, SHOREVIEW, MN 55126-5868
(651) 765-9800
(651) 765-9801
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
38717
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375175000
—
MN
01
—
P00098375
MEDICARE RAILROAD
—
Enumeration date
04/10/2006
Last updated
11/27/2007
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