MEDICARE: K. B. PEDIATRICS, INC.

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	261QH0100X	Health Service Clinic/Center	351468	CA

General Provider Information

NPI Number	:	1669820437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. B. PEDIATRICS, INC.

Provider Business Mailing Address
First Line	:	9532 ANDOVER CIR
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-2342
Country	:	US
Telephone Number	:	714-417-0735
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. UYEN D BUI
Credential	:	M.D.
Telephone Number	:	714-417-0735

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/16/2016

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