Healthcare Provider Details

I. General information

NPI: 1225857642
Provider Name (Legal Business Name): HEI IEONG LOU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SOUTH DR STE 211
MOUNTAIN VIEW CA
94040-4211
US

IV. Provider business mailing address

827 ALTOS OAKS DR STE 4
LOS ALTOS CA
94024-5490
US

V. Phone/Fax

Practice location:
  • Phone: 408-495-5770
  • Fax: 650-912-1129
Mailing address:
  • Phone: 408-495-5770
  • Fax: 650-912-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1226155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: