Provider Demographics
NPI:1700190972
Name:BUI, KIM-ANH (PHARM D)
Entity Type:Individual
Prefix:
First Name:KIM-ANH
Middle Name:
Last Name:BUI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13151 JAMBOREE RD
Mailing Address - Street 2:TUSTIN
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9150
Mailing Address - Country:US
Mailing Address - Phone:714-842-5096
Mailing Address - Fax:
Practice Address - Street 1:13151 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-9150
Practice Address - Country:US
Practice Address - Phone:714-573-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist