Provider Demographics
NPI:1235396136
Name:LIM, KEVIN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
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 1:16525 VON KARMAN AVE
Mailing Address - Street 2:#F
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606
Mailing Address - Country:US
Mailing Address - Phone:949-222-2216
Mailing Address - Fax:949-222-1055
Practice Address - Street 1:16525 VON KARMAN AVE
Practice Address - Street 2:#F
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606
Practice Address - Country:US
Practice Address - Phone:949-222-2216
Practice Address - Fax:949-222-1055
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice