Provider Demographics
NPI:1780901264
Name:BUI, MAI TRAN (DC)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:TRAN
Last Name:BUI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 EL CAJON BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4426
Mailing Address - Country:US
Mailing Address - Phone:619-692-3211
Mailing Address - Fax:619-291-4271
Practice Address - Street 1:10121 DESTINY MOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-2068
Practice Address - Country:US
Practice Address - Phone:619-245-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA12459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA12459OtherMEDICAL BOARD LICENSE