Provider Demographics
NPI:1003037540
Name:LIM, SHAUN HOON (DDS)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:HOON
Last Name:LIM
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 1:13856 W. WADDELL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SURPRIZE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:623-544-8353
Mailing Address - Fax:623-544-8309
Practice Address - Street 1:13856 W. WADDELL
Practice Address - Street 2:SUITE 102
Practice Address - City:SURPRIZE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-544-8353
Practice Address - Fax:623-544-8309
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72181223G0001X
CO77131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice