Provider Demographics
NPI:1417282369
Name:LIM, KRYSTLE SUN (DDS)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:SUN
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 STONY CIR STE 900
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-9512
Mailing Address - Country:US
Mailing Address - Phone:707-579-1100
Mailing Address - Fax:
Practice Address - Street 1:131 STONY CIR STE 900
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-9512
Practice Address - Country:US
Practice Address - Phone:707-579-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist