1073589651 NPI number — MR. THONG TIEN BUI MD

Table of content: MR. THONG TIEN BUI MD (NPI 1073589651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073589651 NPI number — MR. THONG TIEN BUI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUI
Provider First Name:
THONG
Provider Middle Name:
TIEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073589651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1698 E MCANDREWS RD STE 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-5590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-204-1699
Provider Business Mailing Address Fax Number:
971-471-5205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1698 E MCANDREWS RD
Provider Second Line Business Practice Location Address:
STE 280
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-204-1699
Provider Business Practice Location Address Fax Number:
971-471-5205
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD19890 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 081419 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023679001 . This is a "REGENCE BCBS OF ORE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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