Provider Demographics
NPI:1487700209
Name:BUI, MAI QUYNH (DDS)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:QUYNH
Last Name:BUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 65 TH STREET
Mailing Address - Street 2:8
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-1264
Mailing Address - Country:US
Mailing Address - Phone:916-399-1888
Mailing Address - Fax:916-399-9413
Practice Address - Street 1:3811 FLORIN RD
Practice Address - Street 2:26
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1800
Practice Address - Country:US
Practice Address - Phone:916-395-2000
Practice Address - Fax:916-395-4832
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0303429OtherTAXPAYER IDENTIFICATION