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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | Mike Quynh Bui dba The Medicine Shoppe | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| NPI | 1215110713 · 1477942407 · 1942350251 | [sources] | |||
| Registration number | PHA470280 · PHY 47028 · PHY 52530 · PHY 56146 | [sources] | |||
| Sector | Entity/Corporation | [sources] | |||
| Address | 1125 East 17th Street, No. 165, Santa Ana, CA, 92701 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States of America · DHCS
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Department of Health Care Services | - | |||