Charleston Chua MD Medical Spa PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CHARLESTON CHUA MD MEDICAL SPA PLLC

Practice address

4270 S Decatur Blvd Ste A1
Las Vegas, NV 89103-6801

Phone

(725) 529-2482

Fax

(725) 215-9015

NPI assigned

Jul 18, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charleston Chua, MDNPI 1881937449

Title

Owner

Phone

(702) 460-6009

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charleston Chua, M.D.

  • Plastic and Reconstructive Surgery Physician
  • La Mesa, CA
  • NPI 1881937449

  NV

  Medicare reassignment NPD Authorized official
• Johnny Mirador Chua Jr., NURSE PRACTITIONER

  • Nurse Practitioner
  • Las Vegas, NV
  • NPI 1891269734
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1013755362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4270 S DECATUR BLVD STE B1B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891036802",
            "telephone_number": "725-529-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4270 S DECATUR BLVD STE A1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891036801",
            "telephone_number": "725-529-2482",
            "fax_number": "725-215-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON CHUA MD MEDICAL SPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-18",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "CHUA",
        "authorized_official_first_name": "CHARLESTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-460-6009",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakisha Rena Charles
• Michel-Ange Charles
• Nichole Charles
• Tandalaya Charles
• Charleston Chua MD
• Charleston Pediatric SNF LLC
• Charleston Residential Medicine LLC
• Charleston Residential Services LLC
• Charleston Residential Services LLC
• Charleston Residential Services LLC

• Family Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.