Healthcare Provider Details

I. General information

NPI: 1013630227
Provider Name (Legal Business Name): CHARLESTON CHUA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B1B
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

3352 TRANQUIL GARDEN ST
LAS VEGAS NV
89117-3820
US

V. Phone/Fax

Practice location:
  • Phone: 702-460-6009
  • Fax:
Mailing address:
  • Phone: 702-460-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLESTON CHUA
Title or Position: OWNER
Credential: MD
Phone: 702-460-6009