Healthcare Provider Details

I. General information

NPI: 1225436322
Provider Name (Legal Business Name): NGHIA DUY BUI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E LAKE ST
CHICAGO IL
60601
US

IV. Provider business mailing address

70 E LAKE ST
CHICAGO IL
60601-5959
US

V. Phone/Fax

Practice location:
  • Phone: 808-382-7453
  • Fax:
Mailing address:
  • Phone: 808-382-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60868940
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT 2567
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: