Provider Demographics
NPI:1982944294
Name:CHUNG THE BUI, MD
Entity Type:Organization
Organization Name:CHUNG THE BUI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:THE
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-531-2203
Mailing Address - Street 1:10301 BOLSA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6784
Mailing Address - Country:US
Mailing Address - Phone:714-531-2203
Mailing Address - Fax:
Practice Address - Street 1:10301 BOLSA AVE STE 102
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6784
Practice Address - Country:US
Practice Address - Phone:714-531-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43172261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43172Medicaid