Provider Demographics
NPI:1962736926
Name:BUI, GINA N (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:N
Last Name:BUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 TULLY RD STE 309
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:408-993-8536
Mailing Address - Fax:408-993-8539
Practice Address - Street 1:1340 TULLY RD STE 309
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-993-8536
Practice Address - Fax:408-993-8539
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121457208D00000X
PAMD440362208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962736926Medicaid