Provider Demographics
NPI:1275833204
Name:LIM, DANIEL Y (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:Y
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 1:1669 ORCHID WAY
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4264
Mailing Address - Country:US
Mailing Address - Phone:310-386-1799
Mailing Address - Fax:
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:562-634-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist