Healthcare Provider Details

I. General information

NPI: 1912148511
Provider Name (Legal Business Name): QING CHEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD SUITE 304
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

11125 DUNN RD SUITE 304
SAINT LOUIS MO
63136-6132
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-1166
  • Fax: 314-355-4385
Mailing address:
  • Phone: 314-355-1166
  • Fax: 314-355-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number109507
License Number StateMO

VIII. Authorized Official

Name: QING CHEN
Title or Position: PHYSISICAN
Credential: MD
Phone: 314-355-1166