Provider Demographics
NPI:1154416493
Name:BUI, KHANH D (OD)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:D
Last Name:BUI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2415
Mailing Address - Country:US
Mailing Address - Phone:408-281-1311
Mailing Address - Fax:408-281-1331
Practice Address - Street 1:1013 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-2415
Practice Address - Country:US
Practice Address - Phone:408-281-1311
Practice Address - Fax:408-281-1331
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9892T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0098920Medicaid
BX540YMedicare PIN