Provider Demographics
NPI:1518540343
Name:BUI, HOA C
Entity Type:Individual
Prefix:
First Name:HOA
Middle Name:C
Last Name:BUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 N CENTRAL AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2519
Mailing Address - Country:US
Mailing Address - Phone:213-239-4340
Mailing Address - Fax:
Practice Address - Street 1:1118 N CENTRAL AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2519
Practice Address - Country:US
Practice Address - Phone:213-239-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA927801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty