Provider Demographics
NPI:1972825222
Name:CHU, THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 E. CHARLESTON BOULVARD
Mailing Address - Street 2:230-479
Mailing Address - City:LAS VEGAS
Mailing Address - State:NEVADA
Mailing Address - Zip Code:89142
Mailing Address - Country:UM
Mailing Address - Phone:702-734-8014
Mailing Address - Fax:702-734-6677
Practice Address - Street 1:9020 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8932
Practice Address - Country:US
Practice Address - Phone:702-240-4233
Practice Address - Fax:702-242-5901
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant