Healthcare Provider Details

I. General information

NPI: 1437688793
Provider Name (Legal Business Name): JONATHAN BUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE TACOMA
TACOMA WA
98431-5102
US

IV. Provider business mailing address

BAYNE-JONES ARMY COMMUNITY HOSPITAL 1585 THIRD ST
FORT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1110
  • Fax:
Mailing address:
  • Phone: 337-531-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0086404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: