Provider Demographics
NPI:1376724641
Name:THELMA V BUAN MD INC
Entity Type:Organization
Organization Name:THELMA V BUAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-308-3781
Mailing Address - Street 1:540 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3130
Mailing Address - Country:US
Mailing Address - Phone:626-397-4910
Mailing Address - Fax:626-397-4911
Practice Address - Street 1:123 N GARFIELD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3564
Practice Address - Country:US
Practice Address - Phone:626-308-3781
Practice Address - Fax:626-308-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342181Medicaid
CA00A342181Medicaid