Basic Information
| Provider Information | |||||||||
| NPI: | 1063590958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUI | ||||||||
| FirstName: | HO | ||||||||
| MiddleName: | Q. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 E CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937032223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592256100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40597 WESTLAKE DR | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936449024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596835300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A70885 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1063590958 | 05 | CA | MEDICAID | 00A708850 | 05 | CA | MEDICAID |