Provider Demographics
NPI:1891884607
Name:BUI, VUONG VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VUONG
Middle Name:VAN
Last Name:BUI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S LONE HILL AVE
Mailing Address - Street 2:SUITE #185
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5338
Mailing Address - Country:US
Mailing Address - Phone:909-305-1015
Mailing Address - Fax:909-305-1018
Practice Address - Street 1:1331 S LONE HILL AVE
Practice Address - Street 2:SUITE #185
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5338
Practice Address - Country:US
Practice Address - Phone:909-305-1015
Practice Address - Fax:909-305-1015
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49730OtherLICENSE