=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679688964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAI H BUI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8851D CENTRAL AVE #D
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-624-5357
-----------------------------------------------------
Fax | 909-625-5857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5583 NEWBRIAR WAY
-----------------------------------------------------
City | CHINO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-597-8434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 46031
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------