Provider Demographics
NPI:1144258484
Name:BUI, CHARLENE C (PA)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:C
Last Name:BUI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7111 E 21ST STREET N
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-686-7338
Practice Address - Street 1:7111 E 21ST STREET N
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-686-7338
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200267110AMedicaid
KS100416440AMedicaid
KS426765OtherBCBS INDIVIDUAL
KS110718OtherBCBS GROUP
KS482630Medicaid
KS481252306OtherTRICARE WPS
KSP00168535Medicare ID - Type UnspecifiedRAILROAD MDC RENDERING
KS426765Medicare ID - Type UnspecifiedINDIVIDUAL
KSQ23489Medicare UPIN
KS482630Medicaid
KS100416440AMedicaid