MEDICARE: JENNIFER NGOC ANH BUI PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	54225	CA

General Provider Information

NPI Number	:	1578003018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NGOC ANH BUI PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	16228 PALOMINO MESA PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-4446
Country	:	US
Telephone Number	:	858-408-5662
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W SAN BERNARDINO RD STE A
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3797
Country	:	US
Telephone Number	:	626-966-1909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2017
Last Update Date	:	03/02/2017

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