Healthcare Provider Details

I. General information

NPI: 1245894468
Provider Name (Legal Business Name): ANDREW LU YUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/03/2026
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 5A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 7412057
CHICAGO IL
60674-2057
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-5900
  • Fax: 314-747-5936
Mailing address:
  • Phone: 314-747-5900
  • Fax: 314-747-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026000620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: