Provider Demographics
NPI:1104035963
Name:WU, BEN (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL PLAZE STE 350
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA, LOS ANGELES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-794-5750
Mailing Address - Fax:310-208-0756
Practice Address - Street 1:100 MEDICAL PLAZE STE 350
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA, LOS ANGELES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-5750
Practice Address - Fax:310-208-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics