Provider Demographics
NPI:1104887090
Name:BUI, LINH NGUYEN (MD)
Entity type:Individual
Prefix:
First Name:LINH
Middle Name:NGUYEN
Last Name:BUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8856
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-8856
Mailing Address - Country:US
Mailing Address - Phone:949-640-6912
Mailing Address - Fax:
Practice Address - Street 1:3300 W COAST HWY
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4007
Practice Address - Country:US
Practice Address - Phone:949-646-4400
Practice Address - Fax:949-646-4485
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG610582085R0202X
AZ451652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610580Medicaid
CABJ565YMedicare PIN
CAWG61058BMedicare PIN
CAE07557Medicare UPIN