Provider Demographics
NPI:1881937449
Name:CHUA, CHARLESTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLESTON
Middle Name:
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4510 EXECUTIVE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3022
Mailing Address - Country:US
Mailing Address - Phone:702-460-6009
Mailing Address - Fax:916-734-5633
Practice Address - Street 1:4510 EXECUTIVE DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3022
Practice Address - Country:US
Practice Address - Phone:702-460-6009
Practice Address - Fax:619-330-8826
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV212722086S0122X
CAA1464352086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery