Provider Demographics
NPI:1578547105
Name:BUI, MATTHEW H (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:BUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 1 WEST
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-854-9898
Mailing Address - Fax:310-854-1994
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 1 WEST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-854-9898
Practice Address - Fax:310-854-1994
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34055208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ945298Medicaid
AZ86080015085259D013OtherTRIWEST
AZP00254570OtherRAILROAD MEDICARE
AZ103013Medicare ID - Type Unspecified
AZP00254570OtherRAILROAD MEDICARE