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General NPI Number Information
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NPI Number | 1508281403
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Entity Type | Individual
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Provider Name | KIET BUI OD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 1209 PLAZA DR
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City | WEST COVINA
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State | CA
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Zip | 91790-2817
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Country | US
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Telephone | 626-939-2068
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Fax | 626-856-3172
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Provider Business Mailing Address
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Address Line | 10990 KIMBERLY AVE
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City | MONTCLAIR
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State | CA
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Zip | 91763-6071
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Country | US
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Telephone | 626-939-2068
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Fax | 626-856-3172
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14862
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License Number State | CA
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