Provider Demographics
NPI:1770909830
Name:PHONG H BUI INC
Entity type:Organization
Organization Name:PHONG H BUI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-925-9380
Mailing Address - Street 1:16055 BROOKHURST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1544
Mailing Address - Country:US
Mailing Address - Phone:714-839-2400
Mailing Address - Fax:
Practice Address - Street 1:16055 BROOKHURST ST
Practice Address - Street 2:SUITE C
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1544
Practice Address - Country:US
Practice Address - Phone:714-839-2400
Practice Address - Fax:714-839-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101682207R00000X
207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101682OtherLICENCE NUMBER