Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20A14247 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 20A14247 | CA |
NPI | 1194142562 |
---|---|
Provider Name | Chau Quynh Bui |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Redondo Beach, CA 90277-3037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 02/01/2020 |