Provider Demographics
NPI:1477741239
Name:CHESTERFIELD VALLEY DERMATOLOGY PC
Entity Type:Organization
Organization Name:CHESTERFIELD VALLEY DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM-JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-532-0990
Mailing Address - Street 1:100 CHESTERFIELD BUSINESS PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1271
Mailing Address - Country:US
Mailing Address - Phone:636-532-0990
Mailing Address - Fax:636-532-0993
Practice Address - Street 1:100 CHESTERFIELD BUSINESS PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1271
Practice Address - Country:US
Practice Address - Phone:636-532-0990
Practice Address - Fax:636-532-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003969261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty