Provider Demographics
NPI:1689755712
Name:BUI, KENNETH QUANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:QUANG
Last Name:BUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297-G LEE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1738
Mailing Address - Country:US
Mailing Address - Phone:703-538-5500
Mailing Address - Fax:703-538-2503
Practice Address - Street 1:7297-G LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1738
Practice Address - Country:US
Practice Address - Phone:703-538-5500
Practice Address - Fax:703-538-2503
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA81108OtherASSURANT