Healthcare Provider Details

I. General information

NPI: 1336792068
Provider Name (Legal Business Name): NAM G BUI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 E KATELLA AVE STE B
ORANGE CA
92867-5248
US

IV. Provider business mailing address

2901 E KATELLA AVE STE B
ORANGE CA
92867-5248
US

V. Phone/Fax

Practice location:
  • Phone: 714-602-5557
  • Fax: 714-602-3991
Mailing address:
  • Phone: 714-602-5557
  • Fax: 714-602-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: