Healthcare Provider Details

I. General information

NPI: 1841870847
Provider Name (Legal Business Name): ANDY CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE
SAINT LOUIS MO
63117-1818
US

IV. Provider business mailing address

355 GRAND ST
JERSEY CITY NJ
07302-4321
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2000
  • Fax:
Mailing address:
  • Phone: 201-915-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2025010394
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: