Provider Demographics
NPI:1841495157
Name:HIEN BUI, DMD A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:HIEN BUI, DMD A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HIEN
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-658-0691
Mailing Address - Street 1:6255 LUSK BLVD # 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3763
Mailing Address - Country:US
Mailing Address - Phone:858-658-0691
Mailing Address - Fax:858-658-0692
Practice Address - Street 1:6255 LUSK BLVD # 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3763
Practice Address - Country:US
Practice Address - Phone:858-658-0691
Practice Address - Fax:858-658-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty