Provider Demographics
NPI:1023116498
Name:BUI, DONG (MD)
Entity type:Individual
Prefix:
First Name:DONG
Middle Name:
Last Name:BUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9559 BOLSA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5986
Mailing Address - Country:US
Mailing Address - Phone:714-531-4616
Mailing Address - Fax:714-531-4617
Practice Address - Street 1:9559 BOLSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5986
Practice Address - Country:US
Practice Address - Phone:714-531-4616
Practice Address - Fax:714-531-4617
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35748208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357480Medicaid
CAA35748Medicare ID - Type Unspecified
CA00A357480Medicaid