Provider Demographics
NPI:1255859948
Name:BUI, JIMMY DUC (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:DUC
Last Name:BUI
Suffix:
Gender:M
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2240
Mailing Address - Country:US
Mailing Address - Phone:714-200-9216
Mailing Address - Fax:
Practice Address - Street 1:2305 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2240
Practice Address - Country:US
Practice Address - Phone:714-200-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant