Provider Demographics
NPI:1427219245
Name:LIM, RATHANA (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:RATHANA
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, DDS
Mailing Address - Street 1:230 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1236
Mailing Address - Country:US
Mailing Address - Phone:213-422-0928
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVE
Practice Address - Street 2:5TH FLOOR - DEPT OF ORAL & MAXILLOFACIAL SURGERY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2715
Practice Address - Country:US
Practice Address - Phone:504-941-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56788122300000X
LA60891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAFL2077368OtherDEA
FL0701501OtherDEA