Healthcare Provider Details

I. General information

NPI: 1306423405
Provider Name (Legal Business Name): MICHAEL WESLEY BUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 949-903-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA206754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: