Provider Demographics
NPI:1619929551
Name:BUI, DE CAO (MD)
Entity Type:Individual
Prefix:DR
First Name:DE
Middle Name:CAO
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 1:1600 9TH ST
Mailing Address - Street 2:ROOM 205 MAILSTOP 2 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-6414
Mailing Address - Country:US
Mailing Address - Phone:916-654-2431
Mailing Address - Fax:916-654-3186
Practice Address - Street 1:2501 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6143
Practice Address - Country:US
Practice Address - Phone:714-957-5000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA370642083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB1254781OtherDEA
AB1254781OtherDEA
00A370640Medicare ID - Type Unspecified