Provider Demographics
NPI:1225372295
Name:LIM, EUGENE JONGIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JONGIN
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JONG
Other - Middle Name:IN
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2955 HOPETON RD
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1323
Mailing Address - Country:US
Mailing Address - Phone:818-606-1597
Mailing Address - Fax:
Practice Address - Street 1:680 WILSHIRE PL
Practice Address - Street 2:#411
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3931
Practice Address - Country:US
Practice Address - Phone:213-738-7077
Practice Address - Fax:213-738-0111
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61943OtherDENTAL INSURANCE