Provider Demographics
NPI:1174633275
Name:JUN S. LIM, DDS, MS, LTD
Entity Type:Organization
Organization Name:JUN S. LIM, DDS, MS, LTD
Other - Org Name:EDGEBROOK PERIODONTICS & IMPLANTOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:SUP
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:773-794-1299
Mailing Address - Street 1:4801 W. PETERSON AVE
Mailing Address - Street 2:STE #404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:773-794-1299
Mailing Address - Fax:773-794-1629
Practice Address - Street 1:4801 W. PETERSON AVE
Practice Address - Street 2:STE #404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:773-794-1299
Practice Address - Fax:773-794-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty