Healthcare Provider Details

I. General information

NPI: 1164674503
Provider Name (Legal Business Name): LYNETTE BUI ANDERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MAIN ST
SANTA ANA CA
92701-3576
US

IV. Provider business mailing address

200 S MANCHESTER AVE
ORANGE CA
92868-3217
US

V. Phone/Fax

Practice location:
  • Phone: 657-282-6355
  • Fax:
Mailing address:
  • Phone: 714-456-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: