Provider Demographics
NPI:1386767796
Name:SZU, BENJAMIN Y (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:Y
Last Name:SZU
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 1:1125 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3114
Mailing Address - Country:US
Mailing Address - Phone:626-291-2917
Mailing Address - Fax:626-291-2770
Practice Address - Street 1:1125 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3114
Practice Address - Country:US
Practice Address - Phone:626-291-2917
Practice Address - Fax:626-291-2770
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist