Provider Demographics
NPI:1437147436
Name:CHAU, TOM (PA-C)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:CHAU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:THANH
Other - Middle Name:
Other - Last Name:CHAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-218-4250
Mailing Address - Fax:303-218-4247
Practice Address - Street 1:14000 E ARAPAHOE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:303-218-4250
Practice Address - Fax:303-218-4247
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1842363A00000X
CO1059239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30572886Medicaid
COC811665Medicare PIN
COCOA107450Medicare PIN