Provider Demographics
NPI:1326783226
Name:EUDOC PLLC
Entity Type:Organization
Organization Name:EUDOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DENG
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-362-7307
Mailing Address - Street 1:14364 ALTAVISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-6832
Mailing Address - Country:US
Mailing Address - Phone:703-321-6386
Mailing Address - Fax:
Practice Address - Street 1:1520 HUGUENOT RD STE 114
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2477
Practice Address - Country:US
Practice Address - Phone:804-372-3461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty