Healthcare Provider Details

I. General information

NPI: 1144751629
Provider Name (Legal Business Name): CHAU PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S BOULDER HWY
HENDERSON NV
89015-8533
US

IV. Provider business mailing address

1020 S BOULDER HWY
HENDERSON NV
89015-8533
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9030
  • Fax:
Mailing address:
  • Phone: 702-791-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO3142
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A23803
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A23803
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDO3142
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: