Healthcare Provider Details

I. General information

NPI: 1730795147
Provider Name (Legal Business Name): SUONG BUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MCKEE RD STE 10
SAN JOSE CA
95116-1618
US

IV. Provider business mailing address

1501 BERRYESSA RD UNIT 2336
SAN JOSE CA
95133-3370
US

V. Phone/Fax

Practice location:
  • Phone: 315-836-6814
  • Fax:
Mailing address:
  • Phone: 315-836-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: