Healthcare Provider Details

I. General information

NPI: 1144481912
Provider Name (Legal Business Name): LIEN KIM BUI DREW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIEN KIM BUI M.D.

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 SETTLERS TRACE BLVD BLDG 3
LAFAYETTE LA
70508
US

IV. Provider business mailing address

91 SETTLERS TRACE BLVD BLDG 3
LAFAYETTE LA
70508-6089
US

V. Phone/Fax

Practice location:
  • Phone: 337-524-1700
  • Fax: 337-524-1702
Mailing address:
  • Phone: 337-524-1700
  • Fax: 337-524-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.203795
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: