Provider Demographics
NPI:1366166852
Name:BUI, TAMMY TRAM QUYNH (ACSW)
Entity type:Individual
Prefix:MISS
First Name:TAMMY TRAM
Middle Name:QUYNH
Last Name:BUI
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:QUYNH
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACSW
Mailing Address - Street 1:405 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4599
Practice Address - Country:US
Practice Address - Phone:714-200-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAACSW80979OtherCOUNTY OF ORANGE HEALTH CARE AGENCY