Provider Demographics
NPI:1659712008
Name:BUI, TUAN ANH (MD)
Entity Type:Individual
Prefix:DR
First Name:TUAN
Middle Name:ANH
Last Name:BUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICKEY
Other - Middle Name:
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR ADMIN
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-4503
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:649 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2449
Practice Address - Country:US
Practice Address - Phone:609-365-6239
Practice Address - Fax:609-365-5305
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT204497207X00000X
NJ25MA10659500207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0709352Medicaid