Provider Demographics
NPI:1518627041
Name:BUI, KIM HOANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:HOANG
Last Name:BUI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 W MC KINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6193
Mailing Address - Country:US
Mailing Address - Phone:682-558-5972
Mailing Address - Fax:
Practice Address - Street 1:298 W MC KINLEY AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6193
Practice Address - Country:US
Practice Address - Phone:682-558-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87124183500000X
MN124858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist