Provider Demographics
NPI:1134138381
Name:SUN, SHIHPEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIHPEN
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13861 BEACH BLVD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4002
Mailing Address - Country:US
Mailing Address - Phone:714-897-4471
Mailing Address - Fax:714-892-9898
Practice Address - Street 1:13861 BEACH BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4002
Practice Address - Country:US
Practice Address - Phone:714-897-4471
Practice Address - Fax:714-892-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2949101Medicaid