Healthcare Provider Details

I. General information

NPI: 1619985694
Provider Name (Legal Business Name): ST.LOUIS CHINESE COMMUNITY SERVICE CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 OLIVE BLVD
SAINT LOUIS MO
63132-2708
US

IV. Provider business mailing address

8225 OLIVE BLVD
SAINT LOUIS MO
63132-2708
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-1220
  • Fax: 314-989-1220
Mailing address:
  • Phone: 314-989-1200
  • Fax: 314-989-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number112904
License Number StateMO

VIII. Authorized Official

Name: MS. LIP TONG CHUA
Title or Position: CENTER DIRECTOR
Credential: MSW, LCSW
Phone: 314-989-1220