Basic Information
| Provider Information | |||||||||
| NPI: | 1487294492 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOE NGOC BUI DO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 COFFEE ROAD | ||||||||
| Address2: | C3 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095299603 | ||||||||
| FaxNumber: | 2095296610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1205 E, NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953364932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098233111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2020 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUI | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | NGOC | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2096285424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.