Provider Demographics
NPI:1053469528
Name:LIM, MICHELLE KUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KUO
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 JUNEBERRY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-4503
Mailing Address - Country:US
Mailing Address - Phone:714-928-1808
Mailing Address - Fax:
Practice Address - Street 1:500 E. PELTASON DRIVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-9261
Practice Address - Country:US
Practice Address - Phone:949-824-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585680Medicaid