Healthcare Provider Details

I. General information

NPI: 1619929551
Provider Name (Legal Business Name): DE CAO BUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 HARBOR BLVD
COSTA MESA CA
92626-6143
US

IV. Provider business mailing address

1600 9TH ST ROOM 205 MAILSTOP 2 3
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-5000
  • Fax:
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA37064
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA37064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: