Provider Demographics
NPI:1043760598
Name:LIM, SUNG MIN (DDS)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:MIN
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 1:12065 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4130
Mailing Address - Country:US
Mailing Address - Phone:562-584-4288
Mailing Address - Fax:562-584-4488
Practice Address - Street 1:12065 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4130
Practice Address - Country:US
Practice Address - Phone:562-584-4288
Practice Address - Fax:562-584-4488
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65274Medicaid