Provider Demographics
NPI:1275983488
Name:LIM, JI (DMD)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:
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 1:603 SPRING FOREST RD APT F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7250
Mailing Address - Country:US
Mailing Address - Phone:038-983-3694
Mailing Address - Fax:
Practice Address - Street 1:261 BELVOIR HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8193
Practice Address - Country:US
Practice Address - Phone:252-695-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC108121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program