Provider Demographics
NPI:1780618173
Name:BUI, THANHHA THI (DDS)
Entity type:Individual
Prefix:
First Name:THANHHA
Middle Name:THI
Last Name:BUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 W BALL RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3705
Mailing Address - Country:US
Mailing Address - Phone:714-995-3415
Mailing Address - Fax:
Practice Address - Street 1:12079 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3332
Practice Address - Country:US
Practice Address - Phone:714-534-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53579Medicaid