Healthcare Provider Details

I. General information

NPI: 1164494530
Provider Name (Legal Business Name): QING CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 OLD BALLAS RD STE 104
SAINT LOUIS MO
63141-7083
US

IV. Provider business mailing address

PO BOX 411392
SAINT LOUIS MO
63141-1392
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-4949
  • Fax: 314-942-8695
Mailing address:
  • Phone: 314-993-4949
  • Fax: 314-942-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-107706
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number109507
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: