Provider Demographics
NPI:1235585936
Name:LIM, JI YOUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JI
Middle Name:YOUN
Last Name:LIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 OLD DOMINION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3832
Mailing Address - Country:US
Mailing Address - Phone:703-356-8781
Mailing Address - Fax:
Practice Address - Street 1:6858 OLD DOMINION DR STE 100
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3832
Practice Address - Country:US
Practice Address - Phone:703-356-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014151291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics