Provider Demographics
NPI:1154842342
Name:BUI, DUC THI KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUC
Middle Name:THI KIM
Last Name:BUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16125 SE HAWTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3679
Mailing Address - Country:US
Mailing Address - Phone:503-442-5981
Mailing Address - Fax:
Practice Address - Street 1:706 S GAMMON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1302
Practice Address - Country:US
Practice Address - Phone:503-442-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001634-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice