Provider Demographics
NPI:1508570250
Name:BUI, ANDY QUANG (PA-C)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:QUANG
Last Name:BUI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 GOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1484
Mailing Address - Country:US
Mailing Address - Phone:714-890-2950
Mailing Address - Fax:
Practice Address - Street 1:315 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2501
Practice Address - Country:US
Practice Address - Phone:714-422-3056
Practice Address - Fax:714-422-3057
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA63442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant