Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1648402 | CA |
Y | 222Z00000X | Podiatrist | 1648402 | CA |
NPI | 1023672037 |
---|---|
Provider Name | Joseph Bui |
First Address | San Diego, CA 92124-2218 |
Second Address | Fountain Valley, CA 92708-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |