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General NPI Number Information
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NPI Number | 1558084186
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Entity Type | Individual
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Provider Name | PHILIP THUC BUI DMD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 9610 SIERRA AVE, FONTANA, CA 92335
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City | FONTANA
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State | CA
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Zip | 92335
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Country | US
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Telephone | 909-219-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 11 GARDENIA
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City | IRVINE
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State | CA
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Zip | 92620-1984
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Country | US
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Telephone | 714-900-1135
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 108046
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License Number State | CA
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