Provider Demographics
NPI:1003372897
Name:HWANG, CHANHA (DPT)
Entity Type:Individual
Prefix:
First Name:CHANHA
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 S PAVILION CENTER DR UNIT 2601
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1806
Mailing Address - Country:US
Mailing Address - Phone:480-818-2391
Mailing Address - Fax:
Practice Address - Street 1:8174 LAS VEGAS BLVD S STE 109-150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1029
Practice Address - Country:US
Practice Address - Phone:702-883-9528
Practice Address - Fax:702-852-5715
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist