Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE00010394 | WA |
NPI | 1023230612 |
---|---|
Provider Name | Dr. Benjamin Sun |
First Address | Shoreline, WA 98155-3715 |
Second Address | Shoreline, WA 98155-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |