Provider Demographics
NPI:1326278102
Name:CHEN, KEMIN (PA)
Entity Type:Individual
Prefix:
First Name:KEMIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11445 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7108
Mailing Address - Country:US
Mailing Address - Phone:314-428-9543
Mailing Address - Fax:314-428-9542
Practice Address - Street 1:11445 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7108
Practice Address - Country:US
Practice Address - Phone:314-428-9543
Practice Address - Fax:314-428-9542
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744R1102X
MO2014038545208D00000X, 363A00000X
IL085.005369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1744R1102XOther Service ProvidersSpecialistResearch Study
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice