Provider Demographics
NPI:1548252505
Name:BUI, TRIEU THIEN (DO)
Entity type:Individual
Prefix:
First Name:TRIEU
Middle Name:THIEN
Last Name:BUI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10551 MCFADDEN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5329
Mailing Address - Country:US
Mailing Address - Phone:714-839-1276
Mailing Address - Fax:714-839-2192
Practice Address - Street 1:10551 MCFADDEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-5329
Practice Address - Country:US
Practice Address - Phone:714-839-1276
Practice Address - Fax:714-839-2192
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX66010Medicaid
CA00AX66010Medicaid
F89537Medicare UPIN