Provider Demographics
NPI:1497018774
Name:CHEN, DAVID YUAN-SOU (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:YUAN-SOU
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-273-3376
Mailing Address - Fax:888-665-8309
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-273-3376
Practice Address - Fax:888-665-8309
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016011492207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200032619Medicaid