Healthcare Provider Details

I. General information

NPI: 1215066030
Provider Name (Legal Business Name): THIEN DUY BUI DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N CAPITOL AVE STE. 140
SAN JOSE CA
95132-2570
US

IV. Provider business mailing address

1155 N CAPITOL AVE STE. 140
SAN JOSE CA
95132-2570
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-5596
  • Fax: 408-729-5595
Mailing address:
  • Phone: 408-729-5596
  • Fax: 408-729-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: