Provider Demographics
NPI:1366657892
Name:BUI, AI VAN
Entity Type:Individual
Prefix:MR
First Name:AI
Middle Name:VAN
Last Name:BUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10575 GIFFIN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3049
Mailing Address - Country:US
Mailing Address - Phone:858-578-6732
Mailing Address - Fax:
Practice Address - Street 1:2420 ULRIC ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6040
Practice Address - Country:US
Practice Address - Phone:858-467-9201
Practice Address - Fax:858-467-0644
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist