Provider Demographics
NPI:1598231615
Name:BUI, KHUONG ANH (DR)
Entity Type:Individual
Prefix:
First Name:KHUONG
Middle Name:ANH
Last Name:BUI
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3417
Mailing Address - Country:US
Mailing Address - Phone:714-544-7034
Mailing Address - Fax:
Practice Address - Street 1:671 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3417
Practice Address - Country:US
Practice Address - Phone:714-544-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist