Provider Demographics
NPI:1578003018
Name:BUI, JENNIFER NGOC ANH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NGOC ANH
Last Name:BUI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16228 PALOMINO MESA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-4446
Mailing Address - Country:US
Mailing Address - Phone:858-408-5662
Mailing Address - Fax:
Practice Address - Street 1:500 W SAN BERNARDINO RD STE A
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3797
Practice Address - Country:US
Practice Address - Phone:626-966-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical