Provider Demographics
NPI:1164793899
Name:RISKA K. LIM DENTAL CORPORATION
Entity Type:Organization
Organization Name:RISKA K. LIM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RISKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-264-2410
Mailing Address - Street 1:1241 S SOTO ST
Mailing Address - Street 2:SUITE # 117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2652
Mailing Address - Country:US
Mailing Address - Phone:323-264-2410
Mailing Address - Fax:323-264-2241
Practice Address - Street 1:1241 S SOTO ST
Practice Address - Street 2:SUITE # 117
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2652
Practice Address - Country:US
Practice Address - Phone:323-264-2410
Practice Address - Fax:323-264-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty