Healthcare Provider Details

I. General information

NPI: 1558059733
Provider Name (Legal Business Name): HEUN MIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date: 03/21/2025
Reactivation Date: 03/27/2025

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-3237
  • Fax: 314-617-3520
Mailing address:
  • Phone: 314-617-3237
  • Fax: 314-617-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: