Provider Demographics
NPI:1376682427
Name:BUI, HAN PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:PHUONG
Last Name:BUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 BOLSA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5502
Mailing Address - Country:US
Mailing Address - Phone:714-891-6769
Mailing Address - Fax:
Practice Address - Street 1:9191 BOLSA AVE STE 103
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5502
Practice Address - Country:US
Practice Address - Phone:714-891-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice