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1790168474

NPI Code Detail

MEDICARE: MISS AUDREY SAN LEUNG MD

MEDICARE: MISS AUDREY SAN LEUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MD61087441	WA
2	207R00000X	Internal Medicine Physician	R-10441	IA
3	2081P0004X	Spinal Cord Injury Medicine Physician	MD61087441	WA
4	2081P0004X	Spinal Cord Injury Medicine Physician	ML60951455	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790168474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AUDREY SAN LEUNG MD

Provider Business Mailing Address
First Line	:	925 NORTH GRAND BLVD
Second Line	:	ROOM B719
City	:	ST LOUIS
State	:	MO
Zip	:	63106
Country	:	US
Telephone Number	:	314-652-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N GRAND BLVD # B719
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1621
Country	:	US
Telephone Number	:	314-242-9583
Fax Number	:	314-289-7023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	02/05/2026

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Directions to “ MISS AUDREY SAN LEUNG MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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