Basic Information
| Provider Information | |||||||||
| NPI: | 1003555889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUI | ||||||||
| FirstName: | BREANNA | ||||||||
| MiddleName: | MINH | ||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BUI | ||||||||
| OtherFirstName: | PHUONG | ||||||||
| OtherMiddleName: | MINHTHI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5626 MATINA DR | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957571644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6692254490 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1820 J ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958113010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167375555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2022 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | NP95020073 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.