Provider Demographics
NPI:1275775082
Name:GEORGE D. LIM, DMD, INC.
Entity Type:Organization
Organization Name:GEORGE D. LIM, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ADMIN/ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-951-0814
Mailing Address - Street 1:401 S FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3133
Mailing Address - Country:US
Mailing Address - Phone:323-951-0814
Mailing Address - Fax:
Practice Address - Street 1:401 S FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3133
Practice Address - Country:US
Practice Address - Phone:323-951-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE D. LIM, DMD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-26
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275775082OtherDENTICAL
CAG92264OtherDENTI-CAL PROVIDER NUMBER
CA43190OtherDENTAL LICENSE