Provider Demographics
NPI:1245431550
Name:CHEN, EDWARD CHUN-KUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHUN-KUAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:816 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6056
Mailing Address - Country:US
Mailing Address - Phone:314-822-6830
Mailing Address - Fax:
Practice Address - Street 1:816 S KIRKWOOD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6056
Practice Address - Country:US
Practice Address - Phone:314-822-6830
Practice Address - Fax:314-822-6859
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019746207Q00000X
MO2009002140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245431550Medicaid
MO152800015Medicare PIN