Healthcare Provider Details

I. General information

NPI: 1427984954
Provider Name (Legal Business Name): NASMIR KENJAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5559 CHAUVEAU DR
SAINT LOUIS MO
63129-2319
US

IV. Provider business mailing address

5559 CHAUVEAU DR
SAINT LOUIS MO
63129-2319
US

V. Phone/Fax

Practice location:
  • Phone: 314-484-2756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: