Provider Demographics
NPI:1992714125
Name:FUNG, BENSON (DDS)
Entity type:Individual
Prefix:DR
First Name:BENSON
Middle Name:
Last Name:FUNG
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 1:17300 YORBA LINDA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3810
Mailing Address - Country:US
Mailing Address - Phone:714-524-1123
Mailing Address - Fax:714-524-6927
Practice Address - Street 1:17300 YORBA LINDA BLVD STE C
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3810
Practice Address - Country:US
Practice Address - Phone:714-524-1123
Practice Address - Fax:714-524-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice