Provider Demographics
NPI:1215937859
Name:BUI, TAM MINH (MD)
Entity type:Individual
Prefix:DR
First Name:TAM
Middle Name:MINH
Last Name:BUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:SUITE 459
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-545-1133
Mailing Address - Fax:714-545-1144
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:SUITE 459
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-545-1133
Practice Address - Fax:714-545-1144
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59804174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59804Medicaid
CAG59804Medicare PIN
CAG59804Medicaid