Provider Demographics
NPI:1629403878
Name:BUI, PHU MY
Entity Type:Individual
Prefix:
First Name:PHU
Middle Name:MY
Last Name:BUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15245 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9007
Mailing Address - Country:US
Mailing Address - Phone:405-409-5457
Mailing Address - Fax:
Practice Address - Street 1:15245 CANYON RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9007
Practice Address - Country:US
Practice Address - Phone:405-409-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708380Medicaid
OK200049040Medicaid