Provider Demographics
NPI:1376769356
Name:BUI-TILLMAN, CHRISTINE THANH HA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:THANH HA
Last Name:BUI-TILLMAN
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 1:15355 BROOKHURST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7077
Mailing Address - Country:US
Mailing Address - Phone:714-531-5175
Mailing Address - Fax:714-531-2953
Practice Address - Street 1:15355 BROOKHURST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7077
Practice Address - Country:US
Practice Address - Phone:714-531-5175
Practice Address - Fax:714-531-2953
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44572Medicare ID - Type UnspecifiedDENTICAL PROVIDER NUMBER