Provider Demographics
NPI:1033526918
Name:LIM, RACHEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:PAIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3684 ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-1041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5449 HOLLYWOOD BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3454
Practice Address - Country:US
Practice Address - Phone:323-391-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63594122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist