Provider Demographics
NPI:1083650006
Name:LIM, RAYMOND WONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:WONG
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 1:1525 MERIDIAN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5354
Mailing Address - Country:US
Mailing Address - Phone:408-978-1888
Mailing Address - Fax:408-978-1936
Practice Address - Street 1:1525 MERIDIAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5354
Practice Address - Country:US
Practice Address - Phone:408-978-1888
Practice Address - Fax:408-978-1936
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice