Provider Demographics
NPI:1144384967
Name:LIM, ANDREW JUHWAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JUHWAN
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 1:15550 MAIN ST STE B7
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3491
Mailing Address - Country:US
Mailing Address - Phone:760-947-7777
Mailing Address - Fax:760-947-1331
Practice Address - Street 1:15550 MAIN ST STE B7
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3491
Practice Address - Country:US
Practice Address - Phone:760-947-7777
Practice Address - Fax:760-947-1331
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice