Provider Demographics
NPI:1427143072
Name:BUI, CHUNG THE (MD)
Entity type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:THE
Last Name:BUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10301 BOLSA AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6784
Mailing Address - Country:US
Mailing Address - Phone:714-531-2203
Mailing Address - Fax:714-531-2498
Practice Address - Street 1:10301 BOLSA AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6784
Practice Address - Country:US
Practice Address - Phone:714-531-2203
Practice Address - Fax:714-531-2498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A431720Medicaid
F23256Medicare UPIN
CAA43172Medicare ID - Type Unspecified