Provider Demographics
NPI:1164494530
Name:CHEN, QING (MD)
Entity Type:Individual
Prefix:
First Name:QING
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR
Mailing Address - Street 2:STE 205
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8670
Mailing Address - Country:US
Mailing Address - Phone:314-720-0900
Mailing Address - Fax:314-548-2822
Practice Address - Street 1:555 N NEW BALLAS RD STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6844
Practice Address - Country:US
Practice Address - Phone:314-993-4949
Practice Address - Fax:314-548-2822
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109507207RN0300X, 207R00000X
IL036-107706207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81460Medicare UPIN