Provider Demographics
NPI:1508281403
Name:BUI, KIET (OD)
Entity Type:Individual
Prefix:
First Name:KIET
Middle Name:
Last Name:BUI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10990 KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-6071
Mailing Address - Country:US
Mailing Address - Phone:626-939-2068
Mailing Address - Fax:626-856-3172
Practice Address - Street 1:1209 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2817
Practice Address - Country:US
Practice Address - Phone:626-939-2068
Practice Address - Fax:626-856-3172
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist