Healthcare Provider Details

I. General information

NPI: 1487449500
Provider Name (Legal Business Name): MATTHEW BUI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

3170 W OLYMPIC BLVD
LOS ANGELES CA
90006-2400
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6501
  • Fax:
Mailing address:
  • Phone: 408-724-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: