Provider Demographics
NPI:1316152473
Name:BUI, TREVOR VAN
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:VAN
Last Name:BUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 VIA CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2255
Mailing Address - Country:US
Mailing Address - Phone:858-538-2796
Mailing Address - Fax:
Practice Address - Street 1:3650 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2212
Practice Address - Country:US
Practice Address - Phone:619-563-0802
Practice Address - Fax:619-563-0633
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist