Provider Demographics
NPI:1619278108
Name:BUI, PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:BUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13052 NINA PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1304
Mailing Address - Country:US
Mailing Address - Phone:310-319-4698
Mailing Address - Fax:310-319-4908
Practice Address - Street 1:1225 15TH ST
Practice Address - Street 2:910
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1101
Practice Address - Country:US
Practice Address - Phone:310-319-4698
Practice Address - Fax:310-319-4908
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114638208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619278108Medicaid
CA1619278108Medicaid