MEDICARE: BINA C SUJAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26707	CA

General Provider Information

NPI Number	:	1639238702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BINA C SUJAN DDS

Provider Business Mailing Address
First Line	:	5464 SOUTH STREET
Second Line	:	LAKEWOOD DENTAL CENTER
City	:	LAKEWOOD
State	:	CA
Zip	:	90712
Country	:	US
Telephone Number	:	562-866-0705
Fax Number	:

Provider Business Practice Location Address
First Line	:	5464 SOUTH STREET
Second Line	:	LAKEWOOD DENTAL CENTER
City	:	LAKEWOOD
State	:	CA
Zip	:	90712
Country	:	US
Telephone Number	:	562-866-0705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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