Individual
TIET C BUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
57 BRIDGEPORT RD, NEWPORT COAST, CA 92657-1015
(714) 957-5000
Mailing address
57 BRIDGEPORT RD, NEWPORT COAST, CA 92657-1015
(949) 903-6804
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A36495
CA
208D00000X
General Practice Physician
Primary
A36495
CA
Other
Enumeration date
05/17/2006
Last updated
03/07/2023
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