Individual
MARY PHUONG BUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1317 W FOOTHILL BLVD, STE 148, UPLAND, CA 91786-3676
(909) 981-5882
(909) 946-0833
Mailing address
PO BOX 1869, UPLAND, CA 91785-1869
(909) 981-5882
(909) 385-0379
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
20A8116
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX81160
—
CA
Enumeration date
07/12/2006
Last updated
01/30/2020
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