Provider Demographics
NPI:1275820417
Name:BUI, TAN N (DC)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:N
Last Name:BUI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 BALBOA BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1576
Mailing Address - Country:US
Mailing Address - Phone:818-650-8081
Mailing Address - Fax:
Practice Address - Street 1:5435 BALBOA BLVD
Practice Address - Street 2:STE 207
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1576
Practice Address - Country:US
Practice Address - Phone:818-650-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor