Provider Demographics
NPI:1760570071
Name:CHEN, CHAU L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAU L
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD CL
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8401 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-997-3430
Mailing Address - Fax:618-345-1113
Practice Address - Street 1:8401 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-997-3430
Practice Address - Fax:618-345-1113
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51929207R00000X
MO35577207R00000X
IL53838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006000394OtherBCBS
MO112115OtherBCBS
0409008OtherUHC
IL0006000394OtherBCBS
E20930Medicare UPIN