Healthcare Provider Details

I. General information

NPI: 1851305338
Provider Name (Legal Business Name): MICHAEL BUI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 N LOS COYOTES DIAGONAL STE 250
LONG BEACH CA
90808-3939
US

IV. Provider business mailing address

3320 N LOS COYOTES DIAGONAL STE 250
LONG BEACH CA
90808-3939
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-3230
  • Fax: 562-496-3929
Mailing address:
  • Phone: 562-496-3230
  • Fax: 562-496-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104509
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: