Healthcare Provider Details

I. General information

NPI: 1356210793
Provider Name (Legal Business Name): MICHAEL BUI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 SEPULVDA BLVD
TORRANCE CA
90505
US

IV. Provider business mailing address

2505 PATHWAY AVE
SIMI VALLEY CA
93063-0432
US

V. Phone/Fax

Practice location:
  • Phone: 805-304-9811
  • Fax:
Mailing address:
  • Phone: 805-304-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: