Basic Information
| Provider Information | |||||||||
| NPI: | 1942211503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONG | ||||||||
| FirstName: | FAH CHE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | STE. 290 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147811031 | ||||||||
| FaxNumber: | 3147812840 | ||||||||
| Practice Location | |||||||||
| Address1: | 1031 BELLEVUE AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149777455 | ||||||||
| FaxNumber: | 3149777477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 110908 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | 110908 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | 110908 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
No ID Information.