Provider Demographics
NPI:1316025810
Name:BUI-THOMPSON, LOAN K (DO)
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:K
Last Name:BUI-THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 N. CALIFORNIA ST.
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5505
Mailing Address - Country:US
Mailing Address - Phone:209-469-2229
Mailing Address - Fax:
Practice Address - Street 1:2349 N. CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5505
Practice Address - Country:US
Practice Address - Phone:209-469-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics