Provider Demographics
NPI:1396994224
Name:BUI, MINH-PHUONG KHANH (DMD)
Entity type:Individual
Prefix:DR
First Name:MINH-PHUONG
Middle Name:KHANH
Last Name:BUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 64TH AVE
Mailing Address - Street 2:APT 2H
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2541
Mailing Address - Country:US
Mailing Address - Phone:617-777-8161
Mailing Address - Fax:
Practice Address - Street 1:361 E 50TH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-7954
Practice Address - Country:US
Practice Address - Phone:212-355-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0541851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice