Healthcare Provider Details

I. General information

NPI: 1962985291
Provider Name (Legal Business Name): LILIAN B BUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 3C38
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

3279 NORTHAMPTON CT
PLEASANTON CA
94588-3531
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8145
  • Fax:
Mailing address:
  • Phone: 925-989-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number803183
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA95000973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: