Provider Demographics
NPI:1780491308
Name:BUI, BENJAMIN THEODORE (IDHS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:THEODORE
Last Name:BUI
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 BAY MARINA DR
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6398
Mailing Address - Country:US
Mailing Address - Phone:202-834-1496
Mailing Address - Fax:
Practice Address - Street 1:1022 BAY MARINA DR
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6398
Practice Address - Country:US
Practice Address - Phone:202-834-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman