Provider Demographics
NPI:1225189475
Name:SUN, BENJAMIN PINGTZEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PINGTZEE
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 1:32144 AGOURA RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4031
Mailing Address - Country:US
Mailing Address - Phone:818-597-9777
Mailing Address - Fax:818-597-9595
Practice Address - Street 1:32144 AGOURA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4031
Practice Address - Country:US
Practice Address - Phone:818-597-9777
Practice Address - Fax:818-597-9595
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice