Provider Demographics
NPI:1205861820
Name:BUI, SON LAC (DO)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:LAC
Last Name:BUI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-507-2430
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1000 S RAINBOW BLVD # B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-255-4200
Practice Address - Fax:702-255-0260
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205861820Medicaid
NV930OtherSTATE LICENSE