Healthcare Provider Details

I. General information

NPI: 1033700042
Provider Name (Legal Business Name): VIVIAN T BUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

2846 E STEARNS ST
BREA CA
92821-4710
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2151
  • Fax:
Mailing address:
  • Phone: 909-248-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number506568
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number506568
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number506568
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number506568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: